Ed J. Kuijper National Reference Laboratory for Clostridium difficile Leiden University Medical Center
|
|
- Sophia Townsend
- 5 years ago
- Views:
Transcription
1 Clinical spectrum of Clostridium difficile Infection (CDI) and the emergence of hypervirulent strains Ed J. Kuijper National Reference Laboratory for Clostridium difficile Leiden University Medical Center
2 S. Johnson, D. Gerding: Clin Infect Dis 1998:26;
3 Clostridum difficile infection (CDI) Asymptomatic carriership Hospital-acquired diarrhoea mild self-limiting diarrhea cholera-like pseudomembranous colitis Community-acquired diarrhoea Complications toxic megacolon (mortality 65%) colonic perforation protein-losing enteropathy relapses (20%) reactive arthritis
4 Risk factor for C difficilediarrhoea Antibiotic administration; overestimated, at the LUMC 16 (28%) of 57 patients diagnosed with CDAD in a two-year period, did not use any antibiotic for treatment or prophylaxis. Elderly age Duration of hospital (ICU) stay Renal failure Chemotherapy Cancer (solid tumours, leukemia or lyphoma) Gastrointestinal disease or intestinal surgery Antacids, proton pump inhibitors Diabetes mellitus COPD Liver cirrhosis
5 Augustus 2004 Promed; In Canada during a period of 18 months, 189 patients died due to consequences of severe CDAD. Hospitals, nursing homes, community acquired (25%) USA: outbreaks in 7 hospitals in 6 states ; > 50% toxinotype III with 18 bp deletion in TcdC and fluoroquinolone resistant C. difficile NAP1/toxinotype III, REA BI, PCR Ribotype 027
6 New Emerging Clostridium difficile Clinical Mortality within 30 days: 4.7% to 13.8% Complications: 7.1% to 18.2% Relapse rate: 20.8% to 47.2% less response to metronidazole Characteristics of the strain tcda and tcdb tcdc tcdc ermb Binary toxin Positive 18 bp deletion Deletion at 117, frameshift Negative Positive Genotyping of the strain B4 2 B1 R M246 C37 L1 3 2 V6-81 C44 V6-35 V M216 B6 2 M278 9 PCR-ribotyping 027 REA group BI PFGE NAP1 Toxinotyping III Further subtyping REA and MLVA V6-44 V ML 1 1 C1 2191cc C4 C8 3ML ML 4108 I
7 Complications: toxic megacolon, perforation, colectomy, septic shock.
8 Response to metronidazole Pepin et al, CMAJ 2005:40: Response to metronidazole decreased to 25% in compared to 9% in the periode Musher, CID 2005: 40: % persistent symtoms after 10 days of treatment. Al-Nassir et al CID 2008:47: months prospective observation study, vancomycin and/or metronidazole. At day 5, vancomycine more effective in eradication of C. difficile and resolution of diarrhoea. No difference occurred at the end of treatment of 3 months. Recommendation: Assess the response daily and switch when symptoms have not resolved at day 5
9 Response to metronidazole Levels in feces to 9 ugr/gram wet weight in semisolid or watery samples: lower dosage than 500 mg every 8 hours is unlogical hydroxymetabolite similar concentrations inactivation of metronidazole by enterococci modest increase in MIC values might result in ineffectiveness: UK strains of Type 001 collected in had increased MIC values to 3.5 mg/l (agardilution and spiral gradient endpoint testing
10 Severity of CDI General: age, peak leukocytosis and serum creatine level Zar et al. CID 2007:45; Algorithm for severe diarrhoea and treatment withn vancomycin. Score, based on age, temperature, serum albumin level, periphertla WBC, endoscopic evidence of PMC, treatment at ICU. No prospective study with severity markers including a weight for patient comorbidity Recommendation: WBC> 15,000 cells/ul, acutely rising serum creatinine level (e.g 50% above baseline), elevated serum lactate concentration, temperature >38.5 C, evidence of severe colitis (abdominal sign, radiology)
11 Clinical definition of severe CDI admission with CDI at the hospital transfer to ICU (eg shock) surgery for CDI (toxic megacolon, perforation, refractory colitis) death within 30 days with CDI primary or contributive factor
12 Outbreaks due to Type 027 Sporadic cases due to Type 027 Kuijper E, et al. Euro Surveill. 2008;13: July 31th
13 ESCMID and ECDC Background information Guidance documents for infection control, diagnosis and treatment Pan-european surveillance study; Baseline incidence of hospital-acquired and community-acquired C. difficile infections To build a network of laboratories with links to national surveillance institutes Standardization of typing techniques and distribution of reference strains
14 Admission Discharge 48h 4 weeks Healthcare-onset (*) 8 weeks time Community-onset Healthcare-associated Unknown Community-associated (*) : - may be community- or healthcare-associated, depending on case s history. - if healthcare-associated, may have been acquired in the same facility or imported from another.
15
16 Why now? First isolate of 027 in 1988 (France, patient with severe CDAD) Historical database (>6000 strains) of Dale Gerding: , 14 patients with FQ susceptible isolates of 027 Historical isolates and new isolates shared 18bp deletion and binary toxin genes No gradually increase: new epidemic strain since 2002 outbreaks in Canada, USA and Europe No replacement of existing types
17 Rapid spread of type 027 Antibiotic misusage: role of fluoroquinolones and resistance of 027 Age and underlying diseases of the patients Change of attack-rate Change of cleaning of hospital environment Handwashing with ethanol Lack of facilities for isolation and cohort isolation Lack of clinical recognition and late diagnostics Combatting CDAD has insufficient priority in hospital management Transfer of patients with non-diagnosed CDAD between hospitals and countries Alteration of the strain of sporulation, toxin production
18
19 The hospital St. Jansdal hospital in Harderwijk General hospital, 341 beds Number of patients admitted in 2004: 25,625 The laboratory Before march 2005 testing for CDAD referred to Meander Medical Centre, Amersfoort (cytotoxicity test) March: local introduction of a new diagnostic test in St Jansdal: Rapid enzyme-immuno-assay (ICTAB, Meridian)
20 Ribotypering: 027
21 number of patients with CDAD v no se p l ri ap ja n ju ne n ja ja n 0 ju ne Periode April until September 1th, 2005: n=45 patients (58.4/10,000) 9 (20%) died of which 3 (7%) directly to complications of CDAD 10 (22%) patients suffered from relapses
22 Symptoms and signs < 2 weeks Diarrhoea (100%) Fever (53.3%) Abdominal pain (20%) Bloody stools only in 3 patients (6.7%)
23 Laboratory parameters < 2 weeks High white blood cell count: 10-20*109 cells/ml : 47% > 20*109 cells/ml : 23.7% High ESR: mm/hr : 80% >100 mm/hr : 14% High serum creatinin level: 45% micromol/l : > 200 micromol/l : 17.5% Low serum albumin level: < 20 g/l : 7.7%
24 Outcome: Recurrence R/ vancomycine and /or metronidazole Recurrence of diarrhoea: 10 patients (22%) Recurrence more often seen in patients with: Peak white blood cell count > 20*109 cells/ml (p = 0.002; OR = 16, 95% CI ) Peak serum creatinin level > 200 micromol/l (p = 0.03; OR = 7.1, 95% CI )
25 Outcome: Mortality Mortality within 30 days after diagnosis: 9 patients (20%) 3 (7%) as a direct result of CDAD Predictor of mortality: Peak white blood cell count > 20*109 cells/ml within the first 2 weeks following onset of diarrhoea (p = 0.01; OR = 7.8, 95% CI ).
26 Epidemic ended at St. Jansdal Early and rapid diagnostics, introduction of 3-days rule Strict hand hygiene with water and soap Gloves and apron Cohorting of patients with CDAD Effective environmental cleaning with chlorine containing desinfectants Complete banning of fluoroquinolones and restriction of cephalosporins
27 Course of the epidemic and dynamics of antibiotic use in the St.Jansdal hospital Start infectioncontrol measuremen ts Reintroduction of FQ use Ban of all fluoroquinolones (FQ) 10 9 DDD/100 bed-days per month jan feb march april 2005 cefuroxim iv may june july aug sept months ciprofloxacin po + iv oct nov dec jan* feb 2006 incidence CDAD CDAD incidence per admissions per month 150
28
29 Case-control study: 3 different study groups Group I: 45 patients with CDAD Risk factors for CDAD Risk factors for diarrhea due to other cause Group II: 90 randomly selected controls without diarrhoea Group III: 109 patients with noncdad diarrhoea Difference between CDAD and non-cdad diarrhea
30 Crude and adjusted odds ratios for development of diarrhoea, according to demographic, clinical, and pharmaceutical characteristics Clostridium difficile associated diarrhoea Diarrhoea due to other causes Crude odds ratio (95% CI) Adjusted odds ratio (95% CI) * Crude odds ratio (95% CI) Adjusted odds ratio (95% CI) * Age, years (reference) 2.6 ( ) ( ) ( ) ( ) Antibiotics: Any antibiotic Cephalosporines Macrolides Quinolones 15.3 ( )3 7.0 ( )3 4.9 ( ) ( ) ( ) ( , a 18.6) ( ) b 15.3 (2.7 1 p< 0.05 ; 2 p< 0.01 ; 3 p < )2, c * = adjusted for differences in age, duration of hospital stay, co-morbidity (ICD-10), level of care and co-medication. a = additional adjustment for concommitant use of macrolides and quinolons b = additional adjustment for concommitant use of cephalosporines and quinolones c = additional adjustment for concommitant use of cephalosporines and macrolides (0.6 (0.3 (0.1 ( ) 1.0) 1.2) 7.8) 1.8 ( ( ( ( ) 3.7) 2.1) 1.6)
31 Risk for developing CDAD (OR) 70 57, , , = no CE or FQ use 2 = CE therapy = FQ therapy only 4 = combination therapy
32 Population attributable risk percent (PAR%) Cephalosporin therapy: 31% of all antibiotics prescribed PAR% = 56% Fluoroquinolone therapy: 9.5% of all antibiotics prescribed PAR% = 33%
33 Fluoroquinolones Ciprofloxacin lacks in vitro potency against many important anaerobic bacteria Levofloxacin, trovafloxacin, sparfloxacin: good acivity against anaerobic bacteria Methoxyfluoroquinolones (gatifloxacin and moxifloxacin, similar to that of trovafloxacin against a broad spectrum of anaerobic bacteria) Clinical isolates of C. difficile with decreased susceptibility to fluoroquinolones exhibited mutations in either gyra or gyrb Until 2000 no relation of CDAD with ciprofloxacin and oflaxacin
34 Year hospital Quinolon e Design Multivariate ICHE 2001:22; bed USA tertiary care hospital ciprofloxac in Retrospective case-control study (27/54) Ciprofloxacin OR=9.5 Cephalosporine s OR=6.7 EID 2003:9; bed, VAMHCS, Baltimore Levofloxaci n ciprofoxaci n gatifloxaci n Retrospective Case-control study (30/60) CID 2004:38; bed aute care USA hospital Switch levofloxaci n to gatifloxaci n Retrospective case-control study (37/59) Fluoroquinolon es OR=12.7 Cephalosporine s OR=0.4 Clindamycin OR=2.2 Clindamycin OR=7.7 Duration of gatifloxacin OR=11 ICHE 2005:26; Pittsburg h, USA levofloxaci n Retrospective case-control (203/203) Levofloxacin OR=2.0 Ceftriaxon OR=5.4 Clindamycin OR=4.8 31% 6.7% 10% CID 2005: 41; Teaching hospital, Sherbroo k, Canada ciprofloxac in levofloxaci n gatifloxaci n moxifloxaci n Switch levofloxaci n to moxifloxaci n Retrospective cohort (293/5619) Fluoroquinolon es OR=3.44 Cephalosporine s OR= Clindamycin OR=1.77 Moxifloxacin OR=3.14 Cephalosporine s OR =ns Clindamycin OR=ns 35.9% 10% 1.5% Submitted , acute care, nonteaching USA hospital Matched case control study (50/100) Etiologi c fraction s
35 CID price best article 2005
36 Up to December 2007 Until november 2006: 23 HCF Until december 2007: 34 HCF Outbreaks in 14 HCF Sporadic cases in 20 HCF
37
38
39
40 New Emerging Clostridium difficile Clinical - II Attributable mortality within 30 days: 3.8% Complications: 9.6% Relapse rate: 15.8% Severe diarrhoea as 027, but affects younger patients Characteristics of the strain tcda and tcdb tcdc tcdc ermb Binary toxin Positive 39 bp deletion mutation at 184, stopcodon Negative Positive The Netherlands, Northern Ireland, Genotyping of the strain (Scotland, Belgium) PCR-ribotyping 078 Toxinotyping V Further subtyping MLVA?
41 Type 027 outbreak Type 078 outbreak Endemic Type 027 Endemic Type 078 A B
42
43 New aspects of Clostridum difficile CDI in healthy children Klein et al. (CID 2006; 43;807-13) found an unexpectedly high rate of 6.7% CDI in children with diarrhoea who presented to a pediatric emergency department Pregnant women Rouphael NG, et al. Clostridium difficile-associated diarrhea: an emerging threat to pregnant women. Am J Obstet Gynecol Jun;198(6):635.e1-6. Using Emerging Infection Disease network 10 women with severe CDI found Adults without known risk factors
44 High incidence of Clostridium difficileassociated diarrhoea with a community onset in a hyperendemic region in Germany (HP Weil et al : ECCMID, 2007) August 2006-December 2006 in North West Germany with 103 GP s in a 1500 km2 area with 1.7 million inhabitants: Patients (>40 yrs of age) with diarrhoea attending a GP were investigated for CDAD Standardized interview, strain characterization Definitions of ECDC/CDC/ESGCD 1133 patients of which: 113 (10%) had CDI 47 (4.2%) S.enterica 31 (3.7%) campylobacter
45 High incidence of Clostridium difficileassociated diarrhoea with a community onset in a hyperendemic region in Germany Of 113 CDAD episodes, 31 (27%) were not healthcare-associated and not associated with prior antibiotic treatment. CO-CA-CDAD patients were significantly younger, had less underlying diseases, and the course of CDAD was less severe with fewer relapses. Most of CO-HA-CDAD patients (79%) lived in a southern subregion where hospitals with increased CDAD incidence rates were located, whereas COCA-CDAD patients were equally distributed in northwest Germany.
46 Number of tests Number of positive tests
47
48 Of 2,000 randomly selected fecal samples, 2.1% was positive for C. difficile cytotoxin Approximately one-third neither had antibiotic exposure nor recent hospitalisation
49 Clinical characteristics of communityonset Clostridium difficile infection in The Netherlands. Martijn Bauer, Jaap van Dissel, Ed Kuijper Uncontrolled prospective study Of 2,423 patients included, 37 patients (1.5%) CDI 23% had no risk factor for CDI 13 different PCR ribotypes Bauer MP, Goorhuis A, Koster T, et al. Community-onset Clostridium difficile-associated diarrhoea not associated with antibiotic usage. Two case reports with review of the changing epidemiology of Clostridium difficile-associated diarrhoea. Neth J Med 2008; 66(5):
50
51 Antimicrobial susceptibility pattern of Type 027 Clindamycin resistant isolates in Switzerland, Ireland and France Fluoroquinolones susceptible isolates in Sweden Erythromycin susceptible isolates in Germany and Denmark
52 IR8 IR IR9 FR7 IR20 11 IR27 FR1 FR2 IR3 IR6 IR7 IR19 2 IR21 IR24 2 IR ZW3 19 IR IR13 IR5 2 1 IR22 IR25 2 IR IR16 4 ZW16 IR12 32 ZW17 ZW20 2 ZW7 ZW2 ZW8 ZW10 ZW ZW5 ZW6 ZW ZW4 1 Single Locus Variance Double Locus Variance Triple Locus Variance Quadruple Locus Variance ZW21 ErmB positive strains ZW1 1 ZW11 ZW14 ZW19 FR4 16 IR15 FR8 39 ZW12 ZW15 FR5 2 4 IR10 1 FR3 7 ZW IR11 Irish strains Swiss strains French strains FR9 8 FR6
53 Fluoroquinolone resistant Type 027 FP6 Project LSHE-CT European approach to combat outbreaks of Clostridium difficile associated diarrhoea by development of new diagnostic tests P. Spigaglia and P. Mastrantonio (Istituto Superiore di Sanità, Rome, It); C. difficile lacks genes for topoisomerase IV; alterations in the QRDR of either GyrA or GyrB 20 Type 027 strains from the European surveillance study (2005): All 20 contained one amino-acid substitution in GyrA (Thr82 to Ile) Of 20 isolates, 1 had a MIC=6 for moxifloxacin, and 9 had a MIC>32 mg/l
54 Conclusions C difficile type 027 has now affected HCFs in 16 European countries: 9 countries have reported outbreaks and 7 European countries have only reported sporadic cases Antimicrobial pattern to macrolides, clindamycin and fluoroquinolones is not predictable anymore Two countries reported outbreaks due to clindamycin resistant Type 027 New emerging types are likely to arrive in the near future, such as Type 078 CDI in animals merits more attention
Overview of C. difficile infections. Kurt B. Stevenson, MD MPH Professor Division of Infectious Diseases
Overview of C. difficile infections Kurt B. Stevenson, MD MPH Professor Division of Infectious Diseases Conflicts of Interest I have no financial conflicts of interest related to this topic and presentation.
More informationClostridium difficile Colitis
Update on Clostridium difficile Colitis Fredrick M. Abrahamian, D.O., FACEP Associate Professor of Medicine UCLA School of Medicine Director of Education Department of Emergency Medicine Olive View-UCLA
More informationClostridium difficile
Clostridium difficile A Challenge in Long-Term Care Andrew E. Simor, MD, FRCPC Sunnybrook Health Sciences Centre University of Toronto Hosted by Paul Webber paul@webbertraining.com Objectives to understand
More informationShould we test Clostridium difficile for antimicrobial resistance? by author
Should we test Clostridium difficile for antimicrobial resistance? Paola Mastrantonio Department of Infectious Diseases Istituto Superiore di Sanità, Rome,Italy Clostridium difficile infection (CDI) (first
More informationCommunity-Associated C. difficile Infection: Think Outside the Hospital. Maria Bye, MPH Epidemiologist May 1, 2018
Community-Associated C. difficile Infection: Think Outside the Hospital Maria Bye, MPH Epidemiologist Maria.Bye@state.mn.us 651-201-4085 May 1, 2018 Clostridium difficile Clostridium difficile Clostridium
More informationInappropriate Use of Antibiotics and Clostridium difficile Infection. Jocelyn Srigley, MD, FRCPC November 1, 2012
Inappropriate Use of Antibiotics and Clostridium difficile Infection Jocelyn Srigley, MD, FRCPC November 1, 2012 Financial Disclosures } No conflicts of interest } The study was supported by a Hamilton
More informationIncidence of hospital-acquired Clostridium difficile infection in patients at risk
Baptist Health South Florida Scholarly Commons @ Baptist Health South Florida All Publications 5-20-2016 Incidence of hospital-acquired Clostridium difficile infection in patients at risk Christine Ibarra
More informationHealthcare-associated Infections Annual Report December 2018
December 2018 Healthcare-associated Infections Annual Report 2011-2017 TABLE OF CONTENTS INTRODUCTION... 1 METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS INFECTIONS... 2 MRSA SURVEILLANCE... 3 CLOSTRIDIUM
More informationClinical Spectrum of Disease. Clinical Features. Risk Factors. Risk of CDAD According to Antibiotic Class. Fluoroquinolones as Risk Factor for CDAD
Clinical Features Range from mild diarrhea to severe colitis and death Common clinical symptoms include Watery diarrhea Fever Loss of appetite Nausea Abdominal pain/tenderness Less common ileus CDC Fact
More informationInfection Comments First Line Agents Penicillin Allergy History of multiresistant. line treatment: persist for >7 days they may be
Gastrointestinal Infections Infection Comments First Line Agents Penicillin Allergy History of multiresistant Campylobacter Antibiotics not recommended. Erythromycin 250mg PO 6 Alternative to first N/A
More informationClostridium Difficile Primer: Disease, Risk, & Mitigation
Clostridium Difficile Primer: Disease, Risk, & Mitigation KALVIN YU, M.D. CHIEF INTEGRATION OFFICER, SCPMG/SCAL KAISER PERMANENTE ASSOCIATE PROFESSOR INFECTIOUS DISEASE, COLLEGE OF GLOBAL PUBLIC HEALTH,
More information11/2/2015. Update on the Treatment of Clostridium difficile Infections. Disclosure. Objectives
Update on the Treatment of Clostridium difficile Infections Spencer H. Durham, Pharm.D.,BCPS (AQ-ID) Assistant Clinical Professor of Pharmacy Practice Auburn University Harrison School of Pharmacy Kurt
More informationRunning head: CLOSTRIDIUM DIFFICILE 1
Running head: CLOSTRIDIUM DIFFICILE 1 Clostridium difficile Infection Christy Lee Fenton Mountainland Applied Technology College CLOSTRIDIUM DIFFICILE 2 Clostridium difficile Infection Approximately 200,000
More informationClostridium difficile may be found in 1% to 3% of all
ORIGINAL ARTICLE Evaluating contemporary antibiotics as a risk factor for Clostridium difficile infection in surgical trauma patients Kruti Shah, PharmD, BCPS, Leigh Ann Pass, PharmD, BCPS, Mark Cox, PharmD,
More informationPolicy for the Management of Clostridium Difficile
Policy for the Management of Clostridium Difficile Printed copies must not be considered the definitive version DOCUMENT CONTROL POLICY NO. Policy Group Infection Control Committee Author Dr Linsey Batchelor
More informationSource: Portland State University Population Research Center (
Methicillin Resistant Staphylococcus aureus (MRSA) Surveillance Report 2010 Oregon Active Bacterial Core Surveillance (ABCs) Office of Disease Prevention & Epidemiology Oregon Health Authority Updated:
More informationAntibiotic Stewardship at MetroWest Medical Center. Colleen Grocer, RPh, BCOP Co-Chair, Antibiotic Stewardship Committee
Antibiotic Stewardship at MetroWest Medical Center Colleen Grocer, RPh, BCOP Co-Chair, Antibiotic Stewardship Committee Antibiotic Stewardship Committee Subcommittee of Pharmacy and Therapeutics. Also
More informationC.difficile Re-emergence of an Old Pathogen
C.difficile Re-emergence of an Old Pathogen Gonzalo Bearman MD, MPH Assistant Professor of Medicine, Epidemiology and Community Health Associate Hospital Epidemiologist Virginia Commonwealth University
More informationGUIDELINES FOR THE MANAGEMENT OF COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS
Version 3.1 GUIDELINES FOR THE MANAGEMENT OF COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS Date ratified June 2008 Updated March 2009 Review date June 2010 Ratified by Authors Consultation Evidence base Changes
More informationPreventing Multi-Drug Resistant Organism (MDRO) Infections. For National Patient Safety Goal
Preventing Multi-Drug Resistant Organism (MDRO) Infections For National Patient Safety Goal 07.03.01 2009 Methicillin Resistant Staphlococcus aureus (MRSA) About 3-8% of the population at large is a carrier
More informationIDENTIFICATION: PROCESS: Waging the War against C. difficile Radical Multidisciplinary Approaches From a Community Hospital
Waging the War against C. difficile Radical Multidisciplinary Approaches From a Community Hospital Organization Name: St. Joseph Medical Center Type: Acute Care Hospital Contact Person: Leigh Chapman RN,
More informationClostridium Difficile Infection (CDI) Alistair McGregor Hobart Pathology Royal Hobart Hospital TIPCU
Clostridium Difficile Infection (CDI) Alistair McGregor Hobart Pathology Royal Hobart Hospital TIPCU Disclosures I am not Tom Riley The Fidaxomicin guys brought me dinner once Outline ASID/AICA position
More informationSafe Patient Care Keeping our Residents Safe Use Standard Precautions for ALL Residents at ALL times
Safe Patient Care Keeping our Residents Safe 2016 Use Standard Precautions for ALL Residents at ALL times #safepatientcare Do bugs need drugs? Dr Deirdre O Brien Consultant Microbiologist Mercy University
More informationClostridium difficile Surveillance Report 2016
Clostridium difficile Surveillance Report 2016 EMERGING INFECTIONS PROGRAM Clostridium difficile Surveillance Report 2016 Minnesota Department of Health Emerging Infections Program PO Box 64882, St. Paul,
More informationThe Epidemiology Of Clostridium Difficile Infections Among Oncology Patients
Yale University EliScholar A Digital Platform for Scholarly Publishing at Yale Public Health Theses School of Public Health January 2015 The Epidemiology Of Clostridium Difficile Infections Among Oncology
More informationAntibiotic therapy of acute gastroenteritis
Antibiotic therapy of acute gastroenteritis Potential goals Clinical improvement (vs control) Fecal eradication of the pathogen and decrease infectivity Prevent complications Acute gastroenteritis viruses
More informationAntimicrobial Resistance Update for Community Health Services
Antimicrobial Resistance Update for Community Health Services Elizabeth Beech Healthcare Acquired Infection and Antimicrobial Resistance Project Lead NHS England October 2015 elizabeth.beech@nhs.net Superbugs
More informationCDI Management in Post-Acute Care: Part 1
CDI Management in Post-Acute Care: Part 1 Robin Jump, MD, PhD VISN10 Geriatric Research Education and Clinical Center (GRECC) Louis Stokes Cleveland VA Medical Center Case Western Reserve University Robin.Jump@va.gov
More informationPreventing Clostridium difficile Infection (CDI)
1 Preventing Clostridium difficile Infection (CDI) All Hands on Deck to Reduce CDI Skill Nursing Facility Conference July 28, 2017 Idamae Kennedy, MPH,BSN,RN,CIC Liaison Infection Preventionist Healthcare
More informationESAC s Surveillance by Point Prevalence Measurements. by author
ESAC s Surveillance by Point Prevalence Measurements Herman Goossens, MD, PhD ESAC Co-ordinator VAXINFECTIO, Laboratory of Medical Microbiology University of Antwerp, Belgium Outline Background Point Prevalence
More informationImpact of an intervention to control Clostridium difficile infection on hospital- and community-onset disease; an interrupted time series analysis
ORIGINAL ARTICLE EPIDEMIOLOGY Impact of an intervention to control Clostridium difficile infection on hospital- and community-onset disease; an interrupted time series analysis J. Price 1, E. Cheek 2,
More informationRandomized Controlled Trial on Adjunctive Lavage for Severe Peritoneal Dialysis- Related Peritonitis
Randomized Controlled Trial on Adjunctive Lavage for Severe Peritoneal Dialysis- Related Peritonitis Steve SM Wong Alice Ho Miu Ling Nethersole Hospital Background PD peritonitis is a major cause of PD
More informationAntimicrobial Update Stewardship in Primary Care. Clare Colligan Antimicrobial Pharmacist NHS Forth Valley
Antimicrobial Update Stewardship in Primary Care Clare Colligan Antimicrobial Pharmacist NHS Forth Valley Setting the Scene! Consequences of Antibiotic Use? Resistance For an individual patient with
More informationClostridium difficile infection: The Present and the Future
Clostridium difficile infection: The Present and the Future Carlos E. Figueroa Castro, MD Assistant Professor, Division of Infectious Diseases Medical College of Wisconsin November 2014 I have made this
More informationTime interval of increased risk for Clostridium difficile infection after exposure to antibiotics
J Antimicrob Chemother 2012; 67: 742 748 doi:10.1093/jac/dkr508 Advance Access publication 6 December 2011 Time interval of increased risk for Clostridium difficile infection after exposure to antibiotics
More informationClostridium difficile Infection Prevention. Basics of Infection Prevention 2-Day Mini-Course 2012
Clostridium difficile Infection Prevention Basics of Infection Prevention 2-Day Mini-Course 2012 2 Objectives Describe the etiology and epidemiology of C. difficile infection (CDI) Review evidence-based
More informationClostridium difficile Infection: An Update on the Current State of Prevention
Intermountain APIC and Qualis Health present I-APIC HAI Prevention Learning Network Webinar Series Clostridium difficile Infection An Update on the April 11, 2012 Ruth CarricoPhD RN FSHEA CIC Clostridium
More informationHealthcare-associated Infections Annual Report
September 2014 Healthcare-associated Infections Annual Report 2009-2013 Summary Provincial Infection Control Newfoundland Labrador (PIC-NL) has collected data on inpatients and outpatients with healthcare-associated
More informationClostridium difficile Colitis
1 Clostridium difficile Colitis William R. Sonnenberg, MD 2 Disclosure Dr. Sonnenberg has no conflict of interest, financial agreement, or working affiliation with any group or organization. 3 Learning
More informationAntimicrobial Update. Alison MacDonald Area Antimicrobial Pharmacist NHS Highland April 2018
Antimicrobial Update Alison MacDonald Area Antimicrobial Pharmacist NHS Highland alisonc.macdonald@nhs.net April 2018 Starter Questions Setting the scene... What if antibiotics were no longer effective?
More informationGuidelines for Antimicrobial treatment for treatment of confirmed infections adults
Guidelines for Antimicrobial treatment for treatment of confirmed infections adults This guideline gives recommendations for treatment of confirmed infections in adults for children please see the Paediatric
More informationGeorgia State University. Georgia State University. Zirka Thompson. Spring
Georgia State University ScholarWorks @ Georgia State University Public Health Theses School of Public Health Spring 5-11-2012 Comparison of Risk Factors for Clostridium Difficile Infection Among Community
More informationPlease distribute a copy of this information to each provider in your organization.
HEALTH ADVISORY TO: Physicians and other Healthcare Providers Please distribute a copy of this information to each provider in your organization. Questions regarding this information may be directed to
More informationBecker s Hospital Review
Becker s Hospital Review Oct 2, 2014 Top 10 Best Practices for Antimicrobial Stewardship & Hospital Infection Prevention Presented in Cooperation with Today s Panelists: Stacy Pur, RN (Moderator) Vice
More informationCombination vs Monotherapy for Gram Negative Septic Shock
Combination vs Monotherapy for Gram Negative Septic Shock Critical Care Canada Forum November 8, 2018 Michael Klompas MD, MPH, FIDSA, FSHEA Professor, Harvard Medical School Hospital Epidemiologist, Brigham
More informationAntibiotic Updates: Part II
Antibiotic Updates: Part II Fredrick M. Abrahamian, DO, FACEP, FIDSA Health Sciences Clinical Professor of Emergency Medicine David Geffen School of Medicine at UCLA Los Angeles, California Financial Disclosures
More information8/17/2016 ABOUT US REDUCTION OF CLOSTRIDIUM DIFFICILE THROUGH THE USE OF AN ANTIMICROBIAL STEWARDSHIP PROGRAM
Mary Moore, MS CIC MT (ASCP) Infection Prevention Coordinator Great River Medical Center, West Burlington REDUCTION OF CLOSTRIDIUM DIFFICILE THROUGH THE USE OF AN ANTIMICROBIAL STEWARDSHIP PROGRAM ABOUT
More informationCan levaquin treat group b strep
Can levaquin treat group b strep The Borg System is 100 % Can levaquin treat group b strep IBS - Symptoms, Diet and Treatment. IBS, is the common slang term or abbreviation for Irritable Bowel Syndrome
More informationAntibiotic Stewardship in LTC What does this mean?
Antibiotic Stewardship in LTC What does this mean? Kieran Moore FCFP,FRCPC, Diane Lu CCFP KFLA Public Health Disclosure The findings and conclusions represent those of the presenter and may not necessarily
More informationAntibiotic Stewardship in the Hospital Setting
Antibiotic Stewardship in the Hospital Setting G. Evans, MD FRCPC Medical Director, Infection Prevention & Control Kingston General Hospital & Hotel Dieu Hospital EOPIC September 26, 2012 Stewardship stew-ard-ship
More informationExecutive Summary: A Point Prevalence Survey of Antimicrobial Use: Benchmarking and Patterns of Use to Support Antimicrobial Stewardship Efforts
Executive Summary: A Point Prevalence Survey of Antimicrobial Use: Benchmarking and Patterns of Use to Support Antimicrobial Stewardship Efforts Investigational Team: Diane Brideau-Laughlin BSc(Pharm),
More informationmoxifloxacin intravenous, 400mg/250mL, solution for infusion (Avelox ) SMC No. (650/10) Bayer Schering
moxifloxacin intravenous, 400mg/250mL, solution for infusion (Avelox ) SMC No. (650/10) Bayer Schering 05 November 2010 The Scottish Medicines Consortium (SMC) has completed its assessment of the above
More informationCephalosporins, Quinolones and Co-amoxiclav Prescribing Audit
Cephalosporins, Quinolones and Co-amoxiclav Prescribing Audit Executive Summary Background Antibiotic resistance poses a significant threat to public health, as antibiotics underpin routine medical practice.
More informationNewsflash: Hospital Medicine JOHN C. CHRISTENSEN, MD FACP AMERICAN COLLEGE OF PHYSICIANS, UTAH CHAPTER SCIENTIFIC MEETING FEBRUARY 10, 2017
Newsflash: Hospital Medicine JOHN C. CHRISTENSEN, MD FACP AMERICAN COLLEGE OF PHYSICIANS, UTAH CHAPTER SCIENTIFIC MEETING FEBRUARY 10, 2017 Newsflash: Fluoroquinolones Newsflash: Fluoroquinolones Don t
More informationEducational Module for Nursing Assistants in Long-term Care Facilities: Preventing and Managing Clostridium difficile Infections
Educational Module for Nursing Assistants in Long-term Care Facilities: Preventing and Managing Clostridium difficile Infections Minnesota Department of Health Infectious Disease Epidemiology, Prevention,
More informationAntimicrobial Stewardship in the Long Term Care and Outpatient Settings. Carlos Reyes Sacin, MD, AAHIVS
Antimicrobial Stewardship in the Long Term Care and Outpatient Settings Carlos Reyes Sacin, MD, AAHIVS Disclosure Speaker and consultant in HIV medicine for Gilead and Jansen Pharmaceuticals Objectives
More informationSurgical prophylaxis for Gram +ve & Gram ve infection
Surgical prophylaxis for Gram +ve & Gram ve infection Professor Mark Wilcox Clinical l Director of Microbiology & Pathology Leeds Teaching Hospitals & University of Leeds, UK Heath Protection Agency Surveillance
More informationمادة االدوية المرحلة الثالثة م. غدير حاتم محمد
م. مادة االدوية المرحلة الثالثة م. غدير حاتم محمد 2017-2016 ANTIMICROBIAL DRUGS Antimicrobial drugs Lecture 1 Antimicrobial Drugs Chemotherapy: The use of drugs to treat a disease. Antimicrobial drugs:
More informationLifting the lid off CAP guidelines
Lifting the lid off CAP guidelines Dr. Andrew M. Morris September 5, 2007 12:00-13:00 web.mac.com/idologist Objectives 1. To review the epidemiology of community-acquired pneumonia (CAP) 2. To explore
More informationIntra-Abdominal Infections. Jessica Thompson, PharmD, BCPS (AQ-ID) Infectious Diseases Pharmacy Clinical Specialist Renown Health April 19, 2018
Intra-Abdominal Infections Jessica Thompson, PharmD, BCPS (AQ-ID) Infectious Diseases Pharmacy Clinical Specialist Renown Health April 19, 2018 Select guidelines Mazuski JE, et al. The Surgical Infection
More informationVolume 1; Number 7 November 2007
Volume 1; Number 7 November 2007 CONTENTS Page 1 Page 3 Guidance on the Use of Antibacterial Drugs in Lincolnshire Primary Care: Winter 2007/8 NICE Clinical Guideline 54: Urinary Tract Infection in Children
More informationPreventing Clostridium difficile. July 13,
Preventing Clostridium difficile Infection (CDI) July 13, 2011 1 Learning Objectives: Identify recent changes in the epidemiology of CDI, including transmission i and risk ikpopulations. Review recent
More informationMRSA in the United Kingdom status quo and future developments
MRSA in the United Kingdom status quo and future developments Dietrich Mack Chair of Medical Microbiology and Infectious Diseases The School of Medicine - University of Wales Swansea P R I F Y S G O L
More informationReply to Fabre et. al
Reply to Fabre et. al L. Clifford McDonald, 1 Stuart Johnson, 2,3 Johan S. Bakken, 4 Kevin W. Garey, 5 Ciaran Kelly, 6 Dale N. Gerding, 2 1 Centers for Disease Control and Prevention, Atlanta, Georgia;
More informationPharmacist Coordinated Antimicrobial Therapy: OPAT and Transitions of Care
Pharmacist Coordinated Antimicrobial Therapy: OPAT and Transitions of Care Jennifer McCann, PharmD, BCCCP State Director of Clinical Pharmacy Services St. Vincent Health Indiana Conflicts of Interest No
More informationAntimicrobial Stewardship in Scotland PAST, PRESENT, FUTURE CLEANLINESS CHAMPION, CONFERENCE, ABERDEEN 2011
Antimicrobial Stewardship in Scotland PAST, PRESENT, FUTURE CLEANLINESS CHAMPION, CONFERENCE, ABERDEEN 2011 DILIP NATHWANI Chair, Scottish Antimicrobial Prescribing Group Acknowledgements Members of Scottish
More informationGuideline Updates Change is Inevitable Especially in Infectious Diseases!
Guideline Updates Change is Inevitable Especially in Infectious Diseases! Vicky Shah, PharmD, BCPS Assistant Professor of Pharmacy Practice Wilkes University Nesbitt School of Pharmacy 1 Vicky Shah has
More informationHealthcare-associated Infections and Antimicrobial Use Prevalence Survey
Healthcare-associated Infections and Antimicrobial Use Prevalence Survey Shamima Sharmin, M.B.B.S., MSc, MPH Emerging Infections Program New Mexico Department of Health Agenda Recognize healthcare-associated
More informationCarbapenemase-Producing Enterobacteriaceae (CPE)
Carbapenemase-Producing Enterobacteriaceae (CPE) September 21, 2017 Maryam Khan Peel Public Health Madeleine Ashcroft Public Health Ontario Objectives Differentiate the acronyms related to CPE (CPE,CPO,CRE,CRO)
More informationAntimicrobial Stewardship in Scotland
Antimicrobial Stewardship in Scotland UKCPA/FIS Scientific Meeting 18 th November 2010 Triumphs and Unintended Consequences Dr Jacqueline Sneddon Project Lead for Scottish Antimicrobial Prescribing Group
More informationSt. Joseph s General Hospital Vegreville. and. Mary Immaculate Care Centre. Antimicrobial Stewardship Report
St. Joseph s General Hospital Vegreville and Mary Immaculate Care Centre Antimicrobial Stewardship Report January to June 217 Introduction Antibiotics are among the most commonly prescribed medications
More informationPrevention & Management of Infection post Trans Rectal Ultrasound (TRUS) biopsy
Prevention & Management of Infection post Trans Rectal Ultrasound (TRUS) biopsy Dr. Fidelma Fitzpatrick Consultant Microbiologist, Co-chair, NCCP Prostate Bx Infection Project Board Fidelma.fitzpatrick@hse.ie
More informationCost high. acceptable. worst. best. acceptable. Cost low
Key words I Effect low worst acceptable Cost high Cost low acceptable best Effect high Fig. 1. Cost-Effectiveness. The best case is low cost and high efficacy. The acceptable cases are low cost and efficacy
More informationModels for stewardship in Hospital - UK Models Philip Howard Consultant Antimicrobial Pharmacist
Models for stewardship in Hospital - UK Models Philip Howard Consultant Antimicrobial Pharmacist philip.howard2@nhs.net Twitter: @AntibioticLeeds United Kingdom of England, Scotland, Wales & Northern Ireland
More informationCommunity Acquired Pneumonia: An Update on Guidelines
Community Acquired Pneumonia: An Update on Guidelines Claudia Summa, BScPhm Pharmacy Resident September 12, 2006 Objectives To give a brief description of the pathophysiology of community acquired pneumonia
More informationAntimicrobial Prescribing Advice for patients with Clostridium difficile Associated Diarrhoea
For use in: By: For: Antimicrobial Prescribing Advice for patients with Clostridium difficile Division responsible for document: Key words: Names of document authors: Job titles of document authors: Name
More informationPILOT STUDY OF THE ANTIMICROBIAL SUSCEPTIBILITY OF SHIGELLA IN NEW ZEALAND IN 1996
PILOT STUDY OF THE ANTIMICROBIAL SUSCEPTIBILITY OF SHIGELLA IN NEW ZEALAND IN 996 November 996 by Maggie Brett Antibiotic Reference Laboratory ESR Communicable Disease Centre Porirua CONTENTS Page SUMMARY
More informationANTHRAX. INHALATION, INTESTINAL and CUTANEOUS ANTHRAX
INHALATION, INTESTINAL and CUTANEOUS ANTHRAX CPMP/4048/01, rev. 3 1/7 General points on treatment Anthrax is an acute infectious disease caused by Bacillus anthracis, that may be infecting man via cutaneous
More informationObjectives 4/26/2017. Co-Investigators Sadie Giuliani, PharmD, BCPS Claude Tonnerre, MD Jayme Hartzell, PharmD, MS, BCPS
IMPLEMENTATION AND ASSESSMENT OF A GUIDELINE-BASED TREATMENT ALGORITHM FOR COMMUNITY-ACQUIRED PNEUMONIA (CAP) Lucas Schonsberg, PharmD PGY-1 Pharmacy Practice Resident Providence St. Patrick Hospital Missoula,
More informationANTIMICROBIAL STEWARDSHIP IN SCOTLAND. Key achievements of the Scottish Antimicrobial Prescribing Group
ANTIMICROBIAL STEWARDSHIP IN SCOTLAND Key achievements of the Scottish Antimicrobial Prescribing Group Dr Jacqueline Sneddon Project Lead Scottish Antimicrobial Prescribing Group Overview of talk ScotMARAP
More informationHealthcare-associated Infections Annual Report March 2015
March 2015 Healthcare-associated Infections Annual Report 2009-2014 TABLE OF CONTENTS SUMMARY... 1 MRSA SURVEILLANCE RESULTS... 1 CDI SURVEILLANCE RESULTS... 1 INTRODUCTION... 2 METHICILLIN-RESISTANT
More informationIn vitro activity of surotomycin against contemporary clinical isolates of toxigenic Clostridium difficile strains obtained in Spain
J Antimicrob Chemother 2015; 70: 2311 2315 doi:10.1093/jac/dkv092 Advance Access publication 15 April 2015 In vitro activity of surotomycin against contemporary clinical isolates of toxigenic Clostridium
More informationActive Bacterial Core Surveillance Site and Epidemiologic Classification, United States, 2005a. Copyright restrictions may apply.
Impact of routine surgical ward and intensive care unit admission surveillance cultures on hospital-wide nosocomial methicillin-resistant Staphylococcus aureus infections in a university hospital: an interrupted
More informationRecommendations for Implementation of Antimicrobial Stewardship Restrictive Interventions in Acute Hospitals in Ireland
Recommendations for Implementation of Antimicrobial Stewardship Restrictive Interventions in Acute Hospitals in Ireland A report by the Hospital Antimicrobial Stewardship Working Group, a subgroup of the
More informationAntimicrobial Susceptibility Patterns of Salmonella Typhi From Kigali,
In the name of God Shiraz E-Medical Journal Vol. 11, No. 3, July 2010 http://semj.sums.ac.ir/vol11/jul2010/88030.htm Antimicrobial Susceptibility Patterns of Salmonella Typhi From Kigali, Rwanda. Ashok
More informationObjectives. Review basic categories of intra-abdominal infection and their respective treatments. Community acquired intra-abdominal infection
Objectives Review basic categories of intra-abdominal infection and their respective treatments Community acquired intra-abdominal infection Mild/Moderate Severe Acute biliary tract infections Nosocomial
More informationDelayed Prescribing for Minor Infections Resource Pack for Prescribers
Delayed Prescribing for Minor Infections Resource Pack for Prescribers Background: Antibiotic resistance is an alarming threat to modern healthcare, and infectious illness remains a major global threat
More informationStraight Poop about Clostridium difficile. Many Interesting Aspects. Endoscopic Appearance. Pseudomembranous Colitis (PMC)
Straight Poop about Clostridium difficile Jon E. Lutz, M.D. Many Interesting Aspects History Pathology Bacteriology and cell biology Epidemiology Clinical manifestations Drug therapy Alternative therapies
More informationRational management of community acquired infections
Rational management of community acquired infections Dr Tanu Singhal MD, MSc Consultant Pediatrics and Infectious Disease Kokilaben Dhirubhai Ambani Hospital, Mumbai Why is rational management needed?
More informationUpdate on current SAPG projects
Update on current SAPG projects SAPG Network event 2 nd November 2018 Jacqueline Sneddon Scottish Antimicrobial Prescribing Group Safeguarding antibiotics for Scotland, now and for the future Antifungal
More informationSurveillance of Multi-Drug Resistant Organisms
Surveillance of Multi-Drug Resistant Organisms Karen Hoffmann, RN, MS, CIC Associate Director Statewide Program for Infection Control and Epidemiology (SPICE) University of North Carolina School of Medicine
More informationPrescribing Management
Prescribing Management Aim - To consistently promote and improve the safe, clinical and cost effectiveness of prescribing Margaret Maskrey, Lead Clinical Pharmacist, Inverclyde CHCP Why is prescribing
More informationIMPLEMENTATION AND ASSESSMENT OF A GUIDELINE-BASED TREATMENT ALGORITHM FOR COMMUNITY-ACQUIRED PNEUMONIA (CAP)
IMPLEMENTATION AND ASSESSMENT OF A GUIDELINE-BASED TREATMENT ALGORITHM FOR COMMUNITY-ACQUIRED PNEUMONIA (CAP) Lucas Schonsberg, PharmD PGY-1 Pharmacy Practice Resident Providence St. Patrick Hospital Missoula,
More informationEarly observations that infection with Clostridium difficile
CMAJ Patterns of antibiotic use and risk of hospital admission because of Clostridium difficile infection Sandra Dial MD MSc, Abbas Kezouh PhD, Andre Dascal MD, Alan Barkun MD MSc, Samy Suissa PhD @@ See
More informationMulti-Drug Resistant Gram Negative Organisms POLICY REVIEW DATE EXTENDED Printed copies must not be considered the definitive version
Multi-Drug Resistant Gram Negative Organisms POLICY REVIEW DATE EXTENDED 2018 Printed copies must not be considered the definitive version DOCUMENT CONTROL POLICY NO. IC-122 Policy Group Infection Control
More informationPOINT PREVALENCE SURVEY A tool for antibiotic stewardship in hospitals. Koen Magerman Working group Hospital Medicine
POINT PREVALENCE SURVEY A tool for antibiotic stewardship in hospitals Koen Magerman Working group Hospital Medicine Background Strategic plan By means of a point prevalence survey and internal audits
More informationEvaluating the Role of MRSA Nasal Swabs
Evaluating the Role of MRSA Nasal Swabs Josh Arnold, PharmD PGY1 Pharmacy Resident Pharmacy Grand Rounds February 28, 2017 2016 MFMER slide-1 Objectives Identify the pathophysiology of MRSA nasal colonization
More informationAntibiotic resistance: the rise of the superbugs
Antibiotic resistance: the rise of the superbugs Allen Cheng Associate Professor of Infectious Diseases Epidemiology, Alfred Health; Monash University About me Specialist in infectious diseases Head, Infection
More informationANTIBIOTICS IN BLOODY DIARRHEA PROS AND CONS. 6th Danish Pediatric Infectious Diseases Symposium October 2012
ANTIBIOTICS IN BLOODY DIARRHEA PROS AND CONS 6th Danish Pediatric Infectious Diseases Symposium October 2012 Ulrikka Nygaard, MD, PhD Kim Kristensen, MD, DMSc ANTIBIOTICS IN CASE BLOODY DIARRHEA 7 years
More informationbiomérieux, Inc. 100 Rodolphe Street Durham, NC U.S.A. Tel. : (800) Fax : (800)
2014 BIOMÉRIEUX, INC. BIOMÉRIEUX, THE BLUE LOGO, EMPOWERING CLINICAL DECISIONS, API, CHROMID, DIVERSILAB, ETEST, VIDAS, VIGIGUARD, VITEK ARE USED PENDING AND/OR REGISTERED TRADEMARKS BELONGING TO BIOMÉRIEUX
More information