Reply to Fabre et. al
|
|
- Moris Townsend
- 5 years ago
- Views:
Transcription
1 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; 2 Edward Hines Jr Veterans Administration Hospital, Hines, and 3 Loyola University Medical Center, Maywood, Illinois; 4 St Luke s Hospital, Duluth, Minnesota; 5 University of Houston College of Pharmacy, Texas; and 6 Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts Corresponding author: L. Clifford McDonald, MD Centers for Disease Control and Prevention 1600 Clifton Road, MS A35 Atlanta GA, Cmcdonald1@cdc.gov Reply to author- Fabre et al. pose an important question about the evidence in support of the recommendation to move metronidazole to a second line status and whether it is likely to result in net benefit or harm to patients [1]. The evidence supporting our recommendation to relegate metronidazole to second-line therapy of nonsevere CDI in settings where access to vancomycin or fidaxomicin is limited was of high quality. We analyzed five prospective, randomized, controlled trials that showed metronidazole inferior to vancomycin for initial cure as well as sustained response for all patients, not just patients with severe disease [2]. Additional data of lesser quality also Published by Oxford University Press for the Infectious Diseases Society of America This work is written by (a) US Government employee(s) and is in the public domain in the US.
2 support the conclusion that metronidazole is an inferior therapy for CDI, including slower time to response [3], relatively poor response overall [4] and retrospective data showing inferior response even in patients with mildto-moderate disease [5]. The more recent study mentioned by the authors [6] was also a retrospective study that looked at recurrence and 30-day mortality as outcomes; despite propensity matching, the possibility of unmeasured confounding persists (i.e. large sample sizes do not overcome systematic bias); and there has never been a suggestion that vancomycin is superior to metronidazole for preventing recurrence as confirmed in this study. Thirty day mortality for all patients treated with vancomycin vs metronidazole was significantly lower, albeit with most of the reduced mortality in patients with severe CDI. In both the Zar et al.[7] and Johnson et al.[8] prospective, randomized, controlled trials, vancomycin trended toward superiority in the mild disease subgroups and a multivariate analysis by Johnson et al. found vancomycin to be superior overall, independent of disease severity. This suggests a continuous, consistent benefit of vancomycin over metronidazole across a spectrum of disease severity, albeit a smaller measurable effect on outcomes that are more uncommon in mild disease. These data, combined with the poor pharmacokinetic properties of the drug leading to low concentrations of the drug in stool [9] suggest that metronidazole is not an optimal drug for treating this enteric infection. Although cost has been an important practical consideration for selection of CDI treatments, our recommendations were based on relative efficacy of the agents. Availability of an FDA-approved oral solution ( ) and lower acquisition costs for generic capsules should improve access to vancomycin. Both oral metronidazole and vancomycin disrupt the microbiome and there is not consensus that one promotes overgrowth of vancomycin- resistant enterococci more than the other does [10]. Although the previous CDI guidelines recommended metronidazole for patients with mild-to-moderate CDI, those criteria are still not validated and not standardized, suggesting caution for using "mild CDI" as an indication for metronidazole. In addition, these recommendations appear difficult to
3 follow, possibly from ambiguity in severity classification, resulting in poor outcomes when metronidazole is used for what in retrospect is likely severe disease [6, 11].
4 Disclaimer. The findings and conclusions in this report are those of the author(s), and do not necessarily represent the official position of the CDC or the US Department of Veterans Affairs. Potential Conflicts: Dr. Kelly reports grants from NIH NIAID R01 AI116596, grants from Institut Merieux Research grant, during the conduct of the study; personal fees from Facile Therapeutics, personal fees from First Light Biosciences, personal fees from Finch, personal fees from Merck, personal fees from Seres Health, personal fees from Vedanta, personal fees from Artugen, personal fees from Matrivax, outside the submitted work. Dr. Johnson reports personal fees from Bio-K+, personal fees from Synthetic Biologics, personal fees from CutisPharma, outside the submitted work. Dr. Gerding reports personal fees from Merck, personal fees from Rebiotix, personal fees from Summit, personal fees from Da Volterra, personal fees from MGB BioPharma, personal fees from Pfizer, personal fees from Sanofi Pasteur, personal fees from Actelion, grants from Seres, outside the submitted work; In addition, Dr. Gerding has a patent Treatment and Prevention of CDI issued. Dr. Garey reports consultancy fees from Biomerieux, Merck & Co, Summit Pharmaceuticals. Grants from Merck & Co, Summit Pharmaceuticals, and Techlab. Presentation fees from Biomerieux and Merck & Co. All other authors declare no conflicts. References 1. Fabre VD, K; Avdic, E; Cosgrove, S.E. Role of metronidazole in mild Clostridium difficile infections. Clinical Infectious Diseases McDonald LC, Gerding DN, Johnson S, et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis 2018; 66(7): e1-e Wilcox MH, Howe R. Diarrhoea caused by Clostridium difficile: response time for treatment with metronidazole and vancomycin. J Antimicrob Chemother 1995; 36(4): Musher DM, Aslam S, Logan N, et al. Relatively poor outcome after treatment of Clostridium difficile colitis with metronidazole. Clin Infect Dis 2005; 40(11): Siegfried J, Dubrovskaya Y, Flagiello T, et al. Initial Therapy for Mild to Moderate Clostridium difficile Infection: Exploring the Role of Oral Metronidazole Versus Vancomycin in 168 Hospitalized Patients. Infectious Diseases in Clinical Practice 2016; 24(4):
5 6. Stevens VW, Nelson RE, Schwab-Daugherty EM, et al. Comparative Effectiveness of Vancomycin and Metronidazole for the Prevention of Recurrence and Death in Patients With Clostridium difficile Infection. JAMA Intern Med 2017; 177(4): Zar FA, Bakkanagari SR, Moorthi KM, Davis MB. A comparison of vancomycin and metronidazole for the treatment of Clostridium difficile-associated diarrhea, stratified by disease severity. Clin Infect Dis 2007; 45(3): Johnson S, Louie TJ, Gerding DN, et al. Vancomycin, metronidazole, or tolevamer for Clostridium difficile infection: results from two multinational, randomized, controlled trials. Clin Infect Dis 2014; 59(3): Johnson S, Homann SR, Bettin KM, et al. Treatment of asymptomatic Clostridium difficile carriers (fecal excretors) with vancomycin or metronidazole. A randomized, placebo-controlled trial. Ann Intern Med 1992; 117(4): Al-Nassir WN, Sethi AK, Li Y, Pultz MJ, Riggs MM, Donskey CJ. Both oral metronidazole and oral vancomycin promote persistent overgrowth of vancomycin-resistant enterococci during treatment of Clostridium difficile-associated disease. Antimicrob Agents Chemother 2008; 52(7): Patel I, Wungjiranirun M, Theethira T, et al. Lack of adherence to SHEA-IDSA treatment guidelines for Clostridium difficile infection is associated with increased mortality. J Antimicrob Chemother 2017; 72(2):
Clostridium 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 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 informationLearning Objectives 6/1/18
Gulf Coast Multidisciplinary Pharmacotherapy Conference Kelly R. Reveles, PharmD, PhD, BCPS College of Pharmacy, The University of Texas at Austin School of Medicine, UT Health San Antonio Email: kdaniels46@utexas.edu
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 information(c) 2016, Freeman et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International license.
This is a repository copy of In vitro activities of MCB3681 and 8 comparators against Clostridium difficile isolates with known ribotypes and diverse geographical spread. White Rose Research Online URL
More informationOverview 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 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 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 informationSolving the Mysteries of C. difficile Infection
Solving the Mysteries of C. difficile Infection Kevin W. Garey, PharmD, MS, FSHP Professor and Chair Dept of Pharmacy Practice and Translational Research Disclosures Research grant support paid to the
More informationVancomycin for the Treatment of Clostridium difficile Infection: For Whom Is This Expensive Bullet Really Magic?
IDSA LECTURE Vancomycin for the Treatment of Clostridium difficile Infection: For Whom Is This Expensive Bullet Really Magic? Jacques Pepin Department of Microbiology and Infectious Diseases, University
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 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 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 informationImplementation of a Clinical Decision Support Alert for the Management of Clostridium difficile Infection
Antibiotics 2015, 4, 667-674; doi:10.3390/antibiotics4040667 Article OPEN ACCESS antibiotics ISSN 2079-6382 www.mdpi.com/journal/antibiotics Implementation of a Clinical Decision Support Alert for the
More information11/22/2016. Antimicrobial Stewardship Update Disclosures. Outline. No conflicts of interest to disclose
Antimicrobial Stewardship Update 2016 APIC-CI Conference November 17 th, 2016 Jay R. McDonald, MD Chief, ID Section VA St. Louis Health Care System Assistant Professor of medicine Washington University
More informationTitle: Effect of fidaxomicin versus vancomycin on susceptibility to intestinal
AAC Accepted Manuscript Posted Online 18 April 2016 Antimicrob. Agents Chemother. doi:10.1128/aac.02590-15 Copyright 2016, American Society for Microbiology. All Rights Reserved. 1 2 3 Title: Effect of
More informationDoes Screening for MRSA Colonization Have A Role In Healthcare-Associated Infection Prevention Programs?
Does Screening for MRSA Colonization Have A Role In Healthcare-Associated Infection Prevention Programs? John A. Jernigan, MD, MS Division of Healthcare Quality Promotion Centers for Disease Control and
More informationBugs, Drugs, and No More Shoulder Shrugs: The Role for Antimicrobial Stewardship in Long-term Care
Bugs, Drugs, and No More Shoulder Shrugs: The Role for Antimicrobial Stewardship in Long-term Care Molly Curran, PharmD, BCPS Clinical Assistant Professor The University of Texas College of Pharmacy Clinical
More informationMAJOR ARTICLE. Antibiotic treatment is often associated with diarrhea and symptoms ranging from mild abdominal
MAJOR ARTICLE Efficacy of Fidaxomicin Versus Vancomycin as Therapy for Clostridium difficile Infection in Individuals Taking Concomitant Antibiotics for Other Concurrent Infections Kathleen M. Mullane,
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 informationTreatment Duration for Uncomplicated Community-Acquired Pneumonia: The Evidence in Support of 5 Days
Treatment Duration for Uncomplicated Community-Acquired Pneumonia: The Evidence in Support of 5 Days Executive Summary National consensus guidelines created jointly by the Infectious Diseases Society of
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 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 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 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 informationBest Practices for Antimicrobial Stewardship Programs. October 25, :00 AM 5:00 PM New Orleans, LA Room:
Best Practices for Antimicrobial Stewardship Programs October 25, 2016 8:00 AM 5:00 PM New Orleans, LA Room: 288-290 Co-organized by The Society for Healthcare Epidemiology of America (SHEA) and Pediatric
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 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 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 informationASCENSION TEXAS Antimicrobial Stewardship: Practical Implementation Strategies
ASCENSION TEXAS Antimicrobial Stewardship: Practical Implementation Strategies Theresa Jaso, PharmD, BCPS (AQ-ID) Network Clinical Pharmacy Specialist Infectious Diseases Seton Healthcare Family Ascension
More informationNew Antibiotics for MRSA
New Antibiotics for MRSA Faculty Warren S. Joseph, DPM, FIDSA Consultant, Lower Extremity Infectious Diseases Roxborough Memorial Hospital Philadelphia, Pennsylvania Faculty Disclosure Dr. Joseph: Speaker
More informationWhy Antimicrobial Stewardship?
Antimicrobial Stewardship: Why and How CAPT Arjun Srinivasan, MD Associate Director for Healthcare Associated Infection Prevention Programs Division of Healthcare Quality Promotion Why Antimicrobial Stewardship?
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 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 informationAntimicrobial stewardship: Quick, don t just do something! Stand there!
Antimicrobial stewardship: Quick, don t just do something! Stand there! Stanley I. Martin, MD, FACP, FIDSA Director, Division of Infectious Diseases Director, Antimicrobial Stewardship Program Geisinger
More informationAntimicrobial stewardship in managing septic patients
Antimicrobial stewardship in managing septic patients November 11, 2017 Samuel L. Aitken, PharmD, BCPS (AQ-ID) Clinical Pharmacy Specialist, Infectious Diseases slaitken@mdanderson.org Conflict of interest
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 informationPeriod of study: 12 Nov 2002 to 08 Apr 2004 (first subject s first visit to last subject s last visit)
Study Synopsis This file is posted on the Bayer HealthCare Clinical Trials Registry and Results website and is provided for patients and healthcare professionals to increase the transparency of Bayer's
More informationAntibacterial Resistance: Research Efforts. Henry F. Chambers, MD Professor of Medicine University of California San Francisco
Antibacterial Resistance: Research Efforts Henry F. Chambers, MD Professor of Medicine University of California San Francisco Resistance Resistance Dose-Response Curve Antibiotic Exposure Anti-Resistance
More informationSection 10: Antimicrobial Stewardship and Clostridium difficile Infection: A Primer for the Infection Preventionist
Section 10: Antimicrobial Stewardship and Clostridium difficile Infection: A Primer for the Infection Preventionist Antimicrobial stewardship may be a relatively new addition to the job responsibilities
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 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 informationFM - Male, 38YO. MRSA nasal swab (+) Due to positive MRSA nasal swab test, patient will be continued on Vancomycin 1500mg IV q12 for MRSA treatment...
Jillian O Keefe Doctor of Pharmacy Candidate 2016 September 15, 2015 FM - Male, 38YO HPI: Previously healthy male presents to ED febrile (102F) and in moderate distress ~2 weeks after getting a tattoo
More informationTaking Action to Prevent and Manage Multidrug-resistant Organisms and C. difficile in the Nursing Home: Part 2 Understanding the spread
Taking Action to Prevent and Manage Multidrug-resistant Organisms and C. difficile in the Nursing Home: Part 2 Understanding the spread Nimalie D. Stone, MD,MS Division of Healthcare Quality Promotion
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 informationMAGNITUDE OF ANTIMICROBIAL USE. Antimicrobial Stewardship in Acute and Long Term Healthcare Facilities: Design, Implementation and Challenges
Antimicrobial Stewardship in Acute and Long Term Healthcare Facilities: Design, Implementation and Challenges John A. Jernigan, MD, MS Division of Healthcare Quality Promotion Centers for Disease Control
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 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 informationAntimicrobial Stewardship: Setting minimum expectations for optimizing antimicrobial use and addressing resistance
Antimicrobial Stewardship: Setting minimum expectations for optimizing antimicrobial use and addressing resistance Loria Pollack, MD, MPH Centers for Disease Control and Prevention Division of Healthcare
More informationAntimicrobial Stewardship in the Outpatient Setting. ELAINE LADD, PHARMD, ABAAHP, FAARFM OCTOBER 28th, 2016
Antimicrobial Stewardship in the Outpatient Setting ELAINE LADD, PHARMD, ABAAHP, FAARFM OCTOBER 28th, 2016 Abbreviations AMS - Antimicrobial Stewardship Program OP - Outpatient OPS - Outpatient Setting
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 informationInfection Control of Emerging Diseases
2016 EPS Training Event Martin E. Evans, MD Director, VHA MDRO Program National Infectious Diseases Service Lexington, KY & Cincinnati, OH Infection Control of Emerging Diseases 2016 EPS Training Event
More informationImplementing Antibiotic Stewardship in Rural and Critical Access Hospitals
National Center for Emerging and Zoonotic Infectious Diseases Implementing Antibiotic Stewardship in Rural and Critical Access Hospitals Denise Cardo, MD Director, Division of Healthcare Quality Promotion,
More informationOptimize Durations of Antimicrobial Therapy
Optimize Durations of Antimicrobial Therapy Evidence & Application Jill Cowper, Pharm.D. Division Infectious Diseases Pharmacist Parallon Supply Chain Solutions Richmond, VA P: 607 221 5101 jill.butterfield@parallon.com
More informationAntimicrobial Stewardship 101
Antimicrobial Stewardship 101 Betty P. Lee, Pharm.D. Pediatric Infectious Disease/Antimicrobial Stewardship Pharmacist Lucile Packard Children s Hospital Stanford Disclosure I have no actual or potential
More informationOptimizing Antimicrobial Stewardship Activities Based on Institutional Resources
Optimizing Antimicrobial Stewardship Activities Based on Institutional Resources Andrew Hunter, PharmD, BCPS Infectious Diseases Clinical Pharmacy Specialist Michael E. DeBakey VA Medical Center Andrew.hunter@va.gov
More informationSYN-004 (ribaxamase) Sheila Connelly. Digestive Disease Week 2017 Chicago, IL May 7, 2017
SYN-4 (ribaxamase) An Orally-Delivered Beta-Lactamase Protects the Gut Microbiome from Antibiotic-Mediated Damage and Mitigates Propagation of Antibiotic-Resistance Genes in a Porcine Dysbiosis Model Sheila
More information11-ID-10. Committee: Infectious Disease. Title: Creation of a National Campylobacteriosis Case Definition
11-ID-10 Committee: Infectious Disease Title: Creation of a National Campylobacteriosis Case Definition I. Statement of the Problem Although campylobacteriosis is not nationally-notifiable, it is a disease
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 informationAntimicrobial Stewardship in the Hospital Setting
GUIDE TO INFECTION CONTROL IN THE HOSPITAL CHAPTER 12 Antimicrobial Stewardship in the Hospital Setting Authors Dan Markley, DO, MPH, Amy L. Pakyz, PharmD, PhD, Michael Stevens, MD, MPH Chapter Editor
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 informationIs biocide resistance already a clinical problem?
Is biocide resistance already a clinical problem? Stephan Harbarth, MD MS University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland Important points Biocide resistance exists Antibiotic
More informationStudy Protocol. Funding: German Center for Infection Research (TTU-HAARBI, Research Clinical Unit)
Effectiveness of antibiotic stewardship interventions in reducing the rate of colonization and infections due to antibiotic resistant bacteria and Clostridium difficile in hospital patients a systematic
More informationAntimicrobial Cycling. Donald E Low University of Toronto
Antimicrobial Cycling Donald E Low University of Toronto Bad Bugs, No Drugs 1 The Antimicrobial Availability Task Force of the IDSA 1 identified as particularly problematic pathogens A. baumannii and
More informationAntimicrobial Stewardship. October 2012
Antimicrobial Stewardship October 2012 Rising Antimicrobial Resistance Methicillin resistant staphylococcus aureus (MRSA) Vancomycin resistant enterococci (VRE) MDR and extremely drug resistant (XDR TB)
More informationAdvancing Antimicrobial Stewardship in Community and Rural Hospitals
Advancing Antimicrobial Stewardship in Community and Rural Hospitals Whitney Buckel, PharmD, BCPS Infectious Diseases Clinical Pharmacist Intermountain Medical Center Disclosures The SCORE study was supported
More informationThe Core Elements of Antibiotic Stewardship for Nursing Homes
The Core Elements of Antibiotic Stewardship for Nursing Homes APPENDIX B: Measures of Antibiotic Prescribing, Use and Outcomes National Center for Emerging and Zoonotic Infectious Diseases Division of
More informationSummary of unmet need guidance and statistical challenges
Summary of unmet need guidance and statistical challenges Daniel B. Rubin, PhD Statistical Reviewer Division of Biometrics IV Office of Biostatistics, CDER, FDA 1 Disclaimer This presentation reflects
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 informationRisk Factors for Persistent MRSA Colonization in Children with Multiple Intensive Care Unit Admissions
University of Massachusetts Amherst From the SelectedWorks of Nicholas G Reich July, 2013 Risk Factors for Persistent MRSA Colonization in Children with Multiple Intensive Care Unit Admissions Victor O.
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 informationTaking Action to Prevent and Manage Multidrug-resistant Organisms and C. difficile in the Nursing Home: Part 1 Reviewing the organisms
Taking Action to Prevent and Manage Multidrug-resistant Organisms and C. difficile in the Nursing Home: Part 1 Reviewing the organisms Nimalie D. Stone, MD,MS Division of Healthcare Quality Promotion National
More informationGet Your. A Midday Symposium and Live Webinar conducted at the 2018 Midyear Clinical Meeting and Exhibition
Get Your CE IN THE MIDDAY A Midday Symposium and Live Webinar conducted at the 2018 Midyear Clinical Meeting and Exhibition Improving the Lives of Patients with Clostridium Difficile Infection Monday,
More informationHospital Ward Antibiotic Prescribing and the Risks of Clostridium difficile Infection
Research Original Investigation LESS IS MORE Hospital Ward Antibiotic Prescribing and the Risks of Clostridium difficile Infection Kevin Brown, PhD; Kim Valenta, PhD; David Fisman, MD, MSc; Andrew Simor,
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 informationLINEE GUIDA: VALORI E LIMITI
Ferrara 28 novembre 2014 LINEE GUIDA: VALORI E LIMITI Pierluigi Viale Clinica di Malattie Infettive Policlinico S. Orsola Malpighi EVIDENCE BIASED GERIATRIC MEDICINE Older patients with comorbid conditions
More information5/15/17. Core Elements of Outpatient Antibiotic Stewardship: Implementing Antibiotic Stewardship Into Your Outpatient Practice.
National Center for Emerging and Zoonotic Infectious Diseases Core Elements of Outpatient Antibiotic Stewardship: Implementing Antibiotic Stewardship Into Your Outpatient Practice Melinda Neuhauser, PharmD,
More informationMcFarland LV, Mulligan ME, Kwok RY, Stamm WE. Nosocomial. Clabots CR, Johnson S, Olson MM, Peterson LR, Gerding DN. Acquisition
Additional references (web) w1 McFarland LV, Mulligan ME, Kwok RY, Stamm WE. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 1989 Jan 26;320(4):204-10. w2 Clabots CR, Johnson S,
More informationImpact of the pharmacist on a multidisciplinary team in an antimicrobial stewardship program: a quasi-experimental study
Int J Clin harm (2012) 34:290 294 DOI 10.1007/s11096-012-9621-7 SHORT RESEARCH REORT Impact of the pharmacist on a multidisciplinary team in an antimicrobial stewardship program: a quasi-experimental study
More informationGeriatric Mental Health Partnership
Geriatric Mental Health Partnership September 8, 2017 First, let s test your knowledge about antibiotics http://www.cdc.gov/getsmart/community/about/quiz.html 2 Get Smart Antibiotics Quiz Antibiotics fight
More informationAntimicrobial Stewardship Strategy: Formulary restriction
Antimicrobial Stewardship Strategy: Formulary restriction Restricted dispensing of targeted antimicrobials on the hospital s formulary, according to approved criteria. The use of restricted antimicrobials
More informationBarriers to Intravenous Penicillin Use for Treatment of Nonmeningitis
JCM Accepts, published online ahead of print on 7 July 2010 J. Clin. Microbiol. doi:10.1128/jcm.01012-10 Copyright 2010, American Society for Microbiology and/or the Listed Authors/Institutions. All Rights
More informationAntimicrobial Stewardship 101: Fighting Fatal Infection
Antimicrobial Stewardship 101: Fighting Fatal Infection Target Audience: Pharmacists ACPE#: 0202-0000-18-005-L01-P Activity Type: Knowledge-based Target Audience: ACPE#: Activity Type: Disclosures I have
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 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 information2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Process
Quality ID #407: Appropriate Treatment of Methicillin-Susceptible Staphylococcus Aureus (MSSA) Bacteremia National Quality Strategy Domain: Effective Clinical Care 2018 OPTIONS FOR INDIVIDUAL MEASURES:
More informationBacterial skin and soft tissues infections (SSTI) are one of the most common 1. infections among different age groups
Bacterial skin and soft tissues infections (SSTI) are one of the most common 1 infections among different age groups Gram-positive bacteria are the most frequently isolated pathogens from SSTI, with a
More information2019 COLLECTION TYPE: MIPS CLINICAL QUALITY MEASURES (CQMS) MEASURE TYPE: Process High Priority
Quality ID #407: Appropriate Treatment of Methicillin-Susceptible Staphylococcus Aureus (MSSA) Bacteremia National Quality Strategy Domain: Effective Clinical Care Meaningful Measure Area: Healthcare Associated
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 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 informationBurden of disease of antibiotic resistance The example of MRSA. Eva Melander Clinical Microbiology, Lund University Hospital
Burden of disease of antibiotic resistance The example of MRSA Eva Melander Clinical Microbiology, Lund University Hospital Discovery of antibiotics Enormous medical gains Significantly reduced morbidity
More informationClinical Review. Prevention and medical management of Clostridium difficile infection. J Shannon-Lowe, 1 N J Matheson, 2 F J Cooke, 1 S H Aliyu 1 2
For the full versions of these articles see bmj.com Clinical Review Prevention and medical management of Clostridium difficile infection J Shannon-Lowe, 1 N J Matheson, 2 F J Cooke, 1 S H Aliyu 1 2 1 Clinical
More informationAntibiotic Stewardship in the Neonatal Intensive Care Unit. Objectives. Background 4/20/2017. Natasha Nakra, MD April 28, 2017
Antibiotic Stewardship in the Neonatal Intensive Care Unit Natasha Nakra, MD April 28, 2017 Objectives 1. Describe antibiotic use in the NICU 2. Explain the role of antibiotic stewardship in the NICU 3.
More informationImpact of a Standardized Protocol to Address Outbreak of Methicillin-resistant
Impact of a Standardized Protocol to Address Outbreak of Methicillin-resistant Staphylococcus Aureus Skin Infections at a large, urban County Jail System Earl J. Goldstein, MD* Gladys Hradecky, RN* Gary
More informationProphylactic antibiotics for insertion of peritoneal dialysis catheter
Prophylactic antibiotics for insertion of peritoneal dialysis catheter Date written: October 2010 Final submission: September 2012 Author: Maha Yehia GUIDELINES a. Intravenous antibiotic prophylaxis should
More informationLack of Change in Susceptibility of Pseudomonas aeruginosa in a Pediatric Hospital Despite Marked Changes in Antibiotic Utilization
Infect Dis Ther (2014) 3:55 59 DOI 10.1007/s40121-014-0028-8 BRIEF REPORT Lack of Change in Susceptibility of Pseudomonas aeruginosa in a Pediatric Hospital Despite Marked Changes in Antibiotic Utilization
More informationLefamulin Evaluation Against Pneumonia (LEAP 1) Phase 3 Topline Results. September 18, 2017
Lefamulin Evaluation Against Pneumonia (LEAP 1) Phase 3 Topline Results September 18, 2017 Safe Harbor and Disclaimer Any statements in this presentation about future expectations, plans and prospects
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 informationNosocomial Infections: What Are the Unmet Needs
Nosocomial Infections: What Are the Unmet Needs Jean Chastre, MD Service de Réanimation Médicale Hôpital Pitié-Salpêtrière, AP-HP, Université Pierre et Marie Curie, Paris 6, France www.reamedpitie.com
More informationAntibiotic Use Metrics in VA facilities Caring for Veterans with Spinal Cord Injury
Antibiotic Use Metrics in VA facilities Caring for Veterans with Spinal Cord Injury Katie J. Suda, PharmD, M.S. Research Health Scientist VA Center of Innovation for Complex Chronic Healthcare Research
More information