Overview of C. difficile infections. Kurt B. Stevenson, MD MPH Professor Division of Infectious Diseases
|
|
- Sharon Arnold
- 5 years ago
- Views:
Transcription
1 Overview of C. difficile infections Kurt B. Stevenson, MD MPH Professor Division of Infectious Diseases
2 Conflicts of Interest I have no financial conflicts of interest related to this topic and presentation. I have research funding from the National Institutes of Health 2
3 Objectives Review the microbiology of Clostridium difficile Outline epidemiology of C. difficile transmission and infection Discuss the infection prevention and antimicrobial measures to decrease C. difficile infection rates Review treatment strategies for C. difficile infection 3
4 Microbiology Gram-positive spore-forming anaerobic bacteria Found in water, air, and human/animal feces Spores allow it to persist in the environment under harsh conditions It can grow to high concentrations in the human gut in the presence of antibiotics It produces two toxins, A and B. Toxin B interacts with mast cells to produce inflammation and Toxin A releases prostaglandins resulting in diarrhea, inflammation, fever, and abdominal pain 4
5 McDonald, LC et al. New Engl J Med 2005;353:
6 Epidemiology Present in the environment (soil, hospital environment) Hospitals are the major reservoir 3% of healthy adults colonized 20-40% of hospitalized patients colonized Spread on the hands of HCWs Transmitted by the fecal oral route CD spores have been recovered from: Hospital toilets Thermometers Metal bedpans Floors Commodes 6
7 Epidemiology Antibiotic exposure is the single most important risk factor for the development of Clostridium difficile infection (CDI). Up to 85% of patients with CDI have antibiotic exposure in the 28 days before infection Chang HT et al. Infect Control Hosp Epidemiol 2007; 28:
8 Antibiotic Use and CDI More Frequent Later generation cephalosporins Ampicillin/amoxicillin Clindamycin Other penicillins Macrolides Tetracyclines TMP-SMX Bartlett JG N Engl J Med 2002;346:334 Kelly CP et al. N Engl J Med 1994;330:257 Dial S JAMA 2005;294: Less Frequent Ticarcillin-clavulanate Metronidazole Fluoroquinolones Rifampicin 5-Flurouracil Cyclophosphamide doxorubicin Methotrexate NSAIDS Proton-pump inhibitors 8
9 Antibiotic Use and CDI More Frequent Later generation cephalosporins Ampicillin/amoxicillin Clindamycin Other penicillins Macrolides Tetracyclines TMP-SMX Bartlett JG N Engl J Med 2002;346:334 Kelly CP et al. N Engl J Med 1994;330:257 Dial S JAMA 2005;294: Less Frequent Ticarcillin-clavulanate Metronidazole Fluoroquinolones Rifampicin 5-Flurouracil Cyclophosphamide doxorubicin Methotrexate NSAIDS Proton-pump inhibitors 9
10 Increased fluroquinolone use The recent introduction of fluoroquinolones with spectrum of activity against agents of community-acquired pneumonia and respiratory pathogens has dramatically increased their utilization Linder JA et al Am J Med 2005;118:
11 Rising incidence of CDI Data collected from the National Hospital Discharge Survey have been used to assess the increase in CDAD over time From 1996 to 2003, there were an estimated 264,000 and 978,000 discharges for which C. difficile was either the primary or any diagnosis First diagnosis 25,000 (2000), 54,000 (2003) (p<0.001) McDonald LG et al. Emerg Infect Dis 2006;12 (3) Epub ahead of print 11
12 McDonald LG et al. Emerg Infect Dis 2006;12 (3)
13 McDonald LG et al. Emerg Infect Dis 2006;12 (3)
14 McDonald LG et al. Emerg Infect Dis 2006;12 (3)
15 Evidence for CDI-pressure in Hospitals CDI pressure =1 days in unit CDI pressure =5 days in unit Unit A Few patients with active CDI = lower risk of acquiring CDI Unit B More patients with active CDI = higher risk of acquiring CDI Dubberke ER, et al. Clin Infect Dis. 2007;45:
16 Clinical symptoms Onset of fever, diarrhea with frequent watery foulsmelling stools, leukocytosis, abdominal pain Severe CDI: WBC>15,000, serum albumin <3, elevated serum creatinine Can be complicated by development of toxic megacolon with sever sepsis requiring colectomy in most severe cases 16
17 Emergence of hypervirulent outbreak strain Emergence of the NAP-1/BI or epidemic strain of C. difficile has intensified the risks associated with antibiotic exposure. Epidemic strain is resistant to fluoroquinolone antibiotics, which confers a selective advantage. 17
18 CDI Outbreaks Quebec hospitals University of Pittsburgh Increasing reports in the USA and worldwide 18
19 Muto CA, et al. ICHE 26:
20 Muto CA, et al. ICHE 26:
21 Muto CA, et al. ICHE 26:
22 U Pittsburgh Outbreak Multivariable analysis Ceftriaxone OR 5.4 (1.8 to 15.8) 21 cases Clindamycin OR 4.8 ( ) 32 cases Levofloxacin OR 2.0 ( ) 120 cases Other significant factors: diabetes, transplant, H2 blockers, proton pump inhibitors Muto CA, et al. ICHE 26:
23 Loo VG, et al. New Engl J Med 2005;353:
24 Loo VG, et al. New Engl J Med 2005;353:
25 Loo VG, et al. New Engl J Med 2005;353:
26 Variant Epidemic Strains (BI/NAP1) Restriction enzyme analysis (REA) typing=bi PFGE typing=nap1 PCR-Ribotyping=027 Toxinotyping=Type III Increased production of Toxins A and B Produces binary toxin Resistant to fluoroquinolones Exposure to fluoroquinolones and cephalosporins is a risk factor 26
27 McDonald, LC et al. New Engl J Med 2005;353:
28 McDonald, LC et al. New Engl J Med 2005;353:
29 McDonald, LC et al. New Engl J Med 2005;353:
30 McDonald, LC et al. New Engl J Med 2005;353:
31 Warny M, et al. Lancet 2005;366:
32 Mechanisms of Control Prevent cross transmission using infection prevention methods Prevent development of colitis by optimizing antimicrobial use 32
33 33
34 Conclusions 3.6 year study; Oxfordshire, United Kingdom 1200 patients Only 35% of cases were genetically related to at least one previous case. These data show that in a majority of cases, C. difficile infection is not transmitted from another previous symptomatic patient 34
35 35 Infect Control Hosp Epidemiol 2014;35:628
36 36
37 37
38 Recommendations for CDI Prevention Encourage appropriate use of antimicrobials Lab based alert system for immediate notification Conduct CDI surveillance for hospital-onset cases Ensure cleaning and disinfection of the environment Daily bleaching and terminal cleaning Use (Enteric)Contact Precautions for infected pts, single pt room preferred especially if incontinent HH, gloves and gowns Dedicated patient care equipment and CLEAN immediately after use ICHE June 2014
39 Recommendations for CDI Prevention Educate HCP, EVS and administration Educate patients and families about CDI Measure compliance with CDC HH and Enteric Contact precautions ICHE June
40 Special approaches to Prevent CDI Goal to higher HH compliance (93%) During outbreaks, use soap and water upon exit Place suspect CDI pts in contact precautions Prolong duration of precautions after pt becomes asymptomatic until discharge (III) Assess adequacy of room cleaning (III) Use a sporocidal disinfectant Initiate an ASP: PPI restriction, probiotics? 40 ICHE June 2014
41 Impact of antimicrobial optimization Tertiary care hospital; Quebec, Valiquette, et al. Clin Infect Dis 2007;45:S112 41
42 Antimicrobial Stewardship Antimicrobial stewardship includes not only limiting inappropriate use but also optimizing antimicrobial selection, dosing, route, and duration of therapy to maximize clinical cure or prevention of infection while limiting the unintended consequences, such as the emergence of resistance, adverse drug events, and cost. Clin Infect Dis 2007;44:
43 Clin Infect Dis 2007; 44:159 77
44 Evidence-Based Practices Active Strategies Prospective audit with intervention and feedback Formulary restriction and preauthorization Supplemental Strategies Education Guidelines and clinical pathways Antimicrobial cycling Antimicrobial order forms Streamlining or de-escalation of therapy Dose optimization Parenteral to oral conversion Clin Infect Dis 2007; 44:159 77
45 Components of Antimicrobial Management Front End provided at the point of prescribing Formulary Restriction and Preauthorization Interactive decision support Guidelines, order sets Requires additional IT support and personnel (e.g. pharmacists) Back End after the antimicrobial has been prescribed Prospective Feedback Audit Streamlining or de-escalation Dose optimization Parenteral to oral conversion Requires additional personnel support (e.g. pharmacists)
46 46 CDC initiative
47 Antibiotic Time Out Step 1: Build dose, duration, indication into the computer based antibiotic order Step 2: Reflex antibiotic order to require microbiological cultures to be ordered Step 3: Take an Antibiotic Time Out: series of questions the team discusses for each patient on antibiotics 47
48 48 Treatment
49 Treatment Metronidazole Oral vancomycin Fidaxomicin Fecal microbiota transplant Colectomy 49
50 50
51 51
52 52
53 Questions???
Inappropriate 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 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 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 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 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 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 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 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 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 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 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 informationJump Starting Antimicrobial Stewardship
Jump Starting Antimicrobial Stewardship Amanda C. Hansen, PharmD Pharmacy Operations Manager Carilion Roanoke Memorial Hospital Roanoke, Virginia March 16, 2011 Objectives Discuss guidelines for developing
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 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 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 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 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 informationUPDATE ON ANTIMICROBIAL STEWARDSHIP REGULATIONS AND IMPLEMENTATION OF AN AMS PROGRAM
UPDATE ON ANTIMICROBIAL STEWARDSHIP REGULATIONS AND IMPLEMENTATION OF AN AMS PROGRAM Diane Rhee, Pharm.D. Associate Professor of Pharmacy Practice Roseman University of Health Sciences Chair, Valley Health
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 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 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 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 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 informationClostridium difficile: Review of Treatment & Prevention through Antimicrobial Stewardship
Clostridium difficile: Review of Treatment & Prevention through Antimicrobial Stewardship Kim Van Wyk, Pharm.D., BCPS Mountain-Pacific Quality Health Objectives Review epidemiology of Clostridium diffilcile
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 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 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 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 informationAntimicrobial Stewardship
Antimicrobial Stewardship Preventing the Spread of Antibiotic Resistance and Improving Patient Care (Adapted from the Centers for Disease Control and Prevention) What is Stewardship? Antimicrobial stewardship
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 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 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 informationC Diff: The Latest Scope on
C Diff: The Latest Scope on the Poop Kathleen M. Vollman MSN, RN, CCNS, FCCM, FAAN Clinical Nurse Specialist / Consultant ADVANCING NURSING kvollman@comcast.net Northville Michigan www.vollman.com ADVANCING
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 informationAntimicrobial Stewardship
Antimicrobial Stewardship Background Why Antimicrobial Stewardship 30-50% of antibiotic use in hospitals are unnecessary or inappropriate Appropriate antimicrobial use is a medication-safety and patient-safety
More informationGet Smart For Healthcare
Get Smart For Healthcare Know When Antibiotics Work Marry Bardin, Quality Improvement Advisor June 9, 2015 Why We Need to Improve In-patient Antibiotic Use Antibiotics are misused in hospitals Antibiotic
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 informationMisericordia Community Hospital (MCH) Antimicrobial Stewardship Report. July December 2013 Second and Third Quarters 2014
H e a l i n g t h e B o d y E n r i c h i n g t h e M i n d N u r t u r i n g t h e S o u l Misericordia Community Hospital (MCH) Antimicrobial Stewardship Report July December 213 Second and Third Quarters
More informationGrey Nuns Community Hospital (GNCH) Antimicrobial Stewardship Report
H e a l i n g t h e B o d y E n r i c h i n g t h e M i n d N u r t u r i n g t h e S o u l Grey Nuns Community Hospital (GNCH) Antimicrobial Stewardship Report to 214 Table of Contents I. Introduction..
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 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 informationIt s Time to Regulate Antimicrobial Stewardship Standards in Acute Care Settings. Emily Heil, PharmD, BCPS-AQ ID, AAHIVP
It s Time to Regulate Antimicrobial Stewardship Standards in Acute Care Settings Emily Heil, PharmD, BCPS-AQ ID, AAHIVP Conflict of Interest I have no conflicts of interest to disclose related to the content
More informationAntimicrobial Stewardship Programs The Same, but Different. Sara Nausheen, MD Kevin Kern, PharmD
Antimicrobial Stewardship Programs The Same, but Different Sara Nausheen, MD Kevin Kern, PharmD Antimicrobial Stewardship Programs The Same, but Different Objectives: Outline the overall function of an
More informationImpact of Antimicrobial Stewardship Program
Impact of Antimicrobial Stewardship Program Ripal Joshi, Pharm.D. AAHIVP Tampa General Hospital January 28, 2016 Objectives Provide an overview on antimicrobial stewardship programs (ASP) Describe the
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 informationAntimicrobial stewardship
Antimicrobial stewardship Magali Dodemont, Pharm. with the support of Wallonie-Bruxelles International WHY IMPLEMENT ANTIMICROBIAL STEWARDSHIP IN HOSPITALS? Optimization of antimicrobial use To limit the
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 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 informationAntimicrobial Stewardship-way forward. Dr. Sonal Saxena Professor Lady Hardinge Medical College New Delhi
Antimicrobial Stewardship-way forward Dr. Sonal Saxena Professor Lady Hardinge Medical College New Delhi Lets save what we have! What is Antibiotic stewardship? Optimal selection, dose and duration of
More informationCollecting and Interpreting Stewardship Data: Breakout Session
Collecting and Interpreting Stewardship Data: Breakout Session Michael S. Calderwood, MD, MPH Regional Hospital Epidemiologist, Dartmouth-Hitchcock Medical Center March 20, 2019 None Disclosures Outline
More information9/30/2016. Dr. Janell Mayer, Pharm.D., CGP, BCPS Dr. Lindsey Votaw, Pharm.D., CGP, BCPS
Dr. Janell Mayer, Pharm.D., CGP, BCPS Dr. Lindsey Votaw, Pharm.D., CGP, BCPS 1 2 Untoward Effects of Antibiotics Antibiotic resistance Adverse drug events (ADEs) Hypersensitivity/allergy Drug side effects
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 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 informationThe Rise of Antibiotic Resistance: Is It Too Late?
The Rise of Antibiotic Resistance: Is It Too Late? Paul D. Holtom, MD Professor of Medicine and Orthopaedics USC Keck School of Medicine None DISCLOSURES THE PROBLEM Antibiotic resistance is one of the
More informationAntibiotic stewardship in long term care
Antibiotic stewardship in long term care Shira Doron, MD Associate Professor of Medicine Division of Geographic Medicine and Infectious Diseases Tufts Medical Center Boston, MA Consultant to Massachusetts
More informationOther Enterobacteriaceae
GUIDE TO INFECTION CONTROL IN THE HOSPITAL CHAPTER NUMBER 50: Other Enterobacteriaceae Author Kalisvar Marimuthu, MD Chapter Editor Michelle Doll, MD, MPH Topic Outline Topic outline - Key Issues Known
More informationMulti-Drug Resistant Organisms (MDRO)
Multi-Drug Resistant Organisms (MDRO) 2016 What are MDROs? Multi-drug resistant organisms, or MDROs, are bacteria resistant to current antibiotic therapy and therefore difficult to treat. MDROs can cause
More informationAntimicrobial Stewardship
Antimicrobial Stewardship Report: 11 th August 2016 Issue: As part of ensuring compliance with the National Safety and Quality Health Service Standards (NSQHS), Yea & District Memorial Hospital is required
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 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 informationHealthcare Facilities and Healthcare Professionals. Public
Document Title: DOH Guidelines for Antimicrobial Stewardship Programs Document Ref. Number: DOH/ASP/GL/1.0 Version: 1.0 Approval Date: 13/12/2017 Effective Date: 14/12/2017 Document Owner: Applies to:
More informationAntibiotic Stewardship in the LTC Setting
Antibiotic Stewardship in the LTC Setting Joe Litsey, Director of Consulting Services Pharm.D., Board Certified Geriatric Pharmacist Thrifty White Pharmacy Objectives Describe the Antibiotic Stewardship
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 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 informationGrey Nuns Community Hospital (GNCH) Antimicrobial Stewardship July December 2017
Grey Nuns Community Hospital (GNCH) Antimicrobial Stewardship July December 217 Table of Contents Table of Contents... 2 I. Executive Summary... 3 II. GNCH Total Antimicrobial Utilization... 4 III. GNCH
More informationHost, Syndrome, Bug, Drug: Introducing 2 Frameworks to Approach Infectious Diseases Cases with an Antimicrobial Stewardship Focus
Host, Syndrome, Bug, Drug: Introducing 2 Frameworks to Approach Infectious Diseases Cases with an Antimicrobial Stewardship Focus Montana ACP Meeting 2018 September 8, 2018 Staci Lee, MD, MEHP Billings
More informationAntimicrobial Stewardship Strategy:
Antimicrobial Stewardship Strategy: Prospective audit with intervention and feedback Formal assessment of antimicrobial therapy by trained individuals, who make recommendations to the prescribing service
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 informationMisericordia Community Hospital (MCH) Antimicrobial Stewardship Report
Misericordia Community Hospital (MCH) Antimicrobial Stewardship Report July December 216 Table of Contents I. Introduction... 3 II. Executive Summary... 5 III. MCH Antimicrobial Utilization Reports...
More informationAntibiotic Stewardship Beyond Hospital Walls
Antibiotic Stewardship Beyond Hospital Walls Katie Burenheide Foster, PharmD, MS, BCPS, FCCM Pharmacy Clinical Manager & PGY1 Pharmacy Residency Director OBJECTIVES 1. Review what Antibiotic Stewardship
More informationUpdates in Antimicrobial Stewardship
Updates in Antimicrobial Stewardship Andrew Hunter, Pharm.D., BCPS Infectious Diseases Clinical Pharmacy Specialist Michael E. DeBakey VA Medical Center andrew.hunter@va.gov Disclosures No disclosures
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 STEWARDSHIP. Brian Mayhue, Pharm D, CGP Director of Pharmacy Palm Beach Gardens Medical Center
ANTIBIOTIC STEWARDSHIP Brian Mayhue, Pharm D, CGP Director of Pharmacy Palm Beach Gardens Medical Center Antibiotic Resistance It is not difficult to make microbes resistant to penicillin in the laboratory
More informationOBJECTIVES. Fast Facts 3/23/2017. Antibiotic Stewardship Beyond Hospital Walls. Antibiotics are a shared resource and becoming a scarce resource.
Antibiotic Stewardship Beyond Hospital Walls Katie Burenheide Foster, PharmD, MS, BCPS, FCCM Pharmacy Clinical Manager & PGY1 Pharmacy Residency Director OBJECTIVES 1. Review what Antibiotic Stewardship
More informationGASTROINTESTINAL DISEASE IN THE HEALTHCARE SETTING: CLOSTRIDIUM DIFFICILE AND NOROVIRUS
GASTROINTESTINAL DISEASE IN THE HEALTHCARE SETTING: CLOSTRIDIUM DIFFICILE AND NOROVIRUS Kerri A. Thom, MD, MS Assistant Professor, UM School of Medicine Associate Hospital Epidemiologist, UMMC DISCLOSURES
More informationOverview of Antimicrobial Stewardship
Overview of Antimicrobial Stewardship Kurt B. Stevenson, MD, MPH Professor of Medicine and Epidemiology Colleges of Medicine and Public Health Medical Director, Antimicrobial Stewardship Program The Ohio
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 informationAntibiotic Stewardship in the Long Term Care Setting. Lisa Venditti, R.Ph., FASCP, Founder and CEO Long Term Solutions Inc LTSRX.
Antibiotic Stewardship in the Long Term Care Setting Lisa Venditti, R.Ph., FASCP, Founder and CEO Long Term Solutions Inc. 845.208.3328 LTSRX.com 1 Resistant Bacteria Crisis The Centers for Medicare &
More informationCurricular Components for Infectious Diseases EPA
Curricular Components for Infectious Diseases EPA 1. EPA Title Promoting antimicrobial stewardship based on microbiological principles 2. Description of the A key role for subspecialists is to utilize
More informationCommonwealth of Kentucky Antibiotic Stewardship Practice Assessment For Long-Term Care Facilities
Commonwealth of Kentucky Antibiotic Stewardship Practice Assessment For Long-Term Care Facilities Introduction As the problem of antibiotic resistance continues to worsen in all healthcare setting, we
More informationDefine evidence based practices for selection and duration of antibiotics to treat suspected or confirmed neonatal sepsis
GLOBAL AIM: Antibiotic Stewardship Perinatal Quality Improvement Teams (PQITs) will share strategies and lessons learned to develop potentially better practices and employ QI methodologies to establish
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 informationANTIMICROBIAL STEWARDSHIP: THE ROLE OF THE CLINICIAN SAM GUREVITZ PHARM D, CGP BUTLER UNIVERSITY COLLEGE OF PHARMACY AND HEALTH SCIENCES
ANTIMICROBIAL STEWARDSHIP: THE ROLE OF THE CLINICIAN SAM GUREVITZ PHARM D, CGP BUTLER UNIVERSITY COLLEGE OF PHARMACY AND HEALTH SCIENCES 1 Crisis: Antibiotic Resistance Success Strategy 2 OBJECTIVES Discuss
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 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 informationAntimicrobial Mindfulness. Beata Casanas, DO FACP FIDSA Associate Professor Division of Infectious Disease USF Morsani College of Medicine
Antimicrobial Mindfulness Beata Casanas, DO FACP FIDSA Associate Professor Division of Infectious Disease USF Morsani College of Medicine Objectives Provide an overview on antimicrobial stewardship programs
More informationAntibiotics in the trenches: An ER Doc s Perspective
Antibiotics in the trenches: An ER Doc s Perspective Peter Currie, MD Medical Director for Quality Emergency Physicians Professional Association (EPPA) Agenda Emergency Medicine Specific Disease Processes
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 informationAntibiotic Stewardship for Hospital Acquired Infection Prevention
Antibiotic Stewardship for Hospital Acquired Infection Prevention Emi Minejima, PharmD Assistant Professor of Clinical Pharmacy USC School of Pharmacy minejima@usc.edu Objectives Review the elements of
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 informationDATA COLLECTION SECTION BY FRONTLINE TEAM. Patient Identifier/ Medical Record number (for facility use only)
Assessment of Appropriateness of ICU Antibiotics (Patient Level Sheet) **Note this is intended for internal purposes only. Please do not return to PQC.** For this assessment, inappropriate antibiotic use
More informationInfection Control & Prevention
Infection Control & Prevention Objectives: Define the term multi-drug resistant organism (MDRO). Recognize risk factors for developing MDROs. Describe the clinical manifestations and medical treatment
More informationAntimicrobial Stewardship Program. Jason G. Newland MD, MEd Miranda Nelson, PharmD
Antimicrobial Stewardship Program Jason G. Newland MD, MEd Miranda Nelson, PharmD The Children's Mercy Hospital, 2015 Antibiotic Timeline Clatworthy 2007 Antibiotic Use in Freestanding Children s Hospitals
More informationAntibiotic Stewardship in Nursing Homes SAM GUREVITZ PHARM D, CGP ASSOCIATE PROFESSOR BUTLER UNIVERSITY COLLEGE OF PHARMACY AND HEALTH SCIENCE
Antibiotic Stewardship in Nursing Homes SAM GUREVITZ PHARM D, CGP ASSOCIATE PROFESSOR BUTLER UNIVERSITY COLLEGE OF PHARMACY AND HEALTH SCIENCE Crisis: Antibiotic Resistance Success Strategy WWW.optimistic-care.org
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 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 informationCHAPTER:1 THE RATIONAL USE OF ANTIBIOTICS. BY Mrs. K.SHAILAJA., M. PHARM., LECTURER DEPT OF PHARMACY PRACTICE, SRM COLLEGE OF PHARMACY
CHAPTER:1 THE RATIONAL USE OF ANTIBIOTICS BY Mrs. K.SHAILAJA., M. PHARM., LECTURER DEPT OF PHARMACY PRACTICE, SRM COLLEGE OF PHARMACY Antibiotics One of the most commonly used group of drugs In USA 23
More informationMDRO s, Stewardship and Beyond. Linda R. Greene RN, MPS, CIC
MDRO s, Stewardship and Beyond Linda R. Greene RN, MPS, CIC linda_greene@urmc.rochester.edu Evolving Threat of Antimicrobial Resistance Why are MDROs important? Limited treatment options Associated with:
More informationRational use of antibiotics
Rational use of antibiotics Uga Dumpis MD, PhD,, DTM Stradins University Hospital Riga, Latvia ugadumpis@stradini.lv BALTICCARE CONFERENCE, PSKOV, 16-18.03, 18.03, 2006 Why to use antibiotics? Prophylaxis
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 information