Clinical Spectrum of Disease. Clinical Features. Risk Factors. Risk of CDAD According to Antibiotic Class. Fluoroquinolones as Risk Factor for CDAD
|
|
- Jessie Berry
- 6 years ago
- Views:
Transcription
1 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 Sheet. August 24 (updated 7/22/25). Clinical Spectrum of Disease Asymptomatic colonization Mild to severe diarrhea (CDAD) More severe disease and increased mortality in multiple recent reports Pseudomembranous colitis Toxic megacolon Perforation of the colon Septic shock Death may occur (rarely) CDC Fact Sheet. August 24 (updated 7/22/5). Risk Factors Two most important risk factors Prior antimicrobial use Length of stay in a healthcare setting or long-term care facility Other risk factors Advancing age Serious underlying illness Gastrointestinal surgery or manipulation Bignardi GE. J Hosp Infect. 1998;4:1-15. Pépin J, et al. Clin Infect Dis. 25:41: Gaynes R, et al. Clin Infect Dis. 24;38: CDC Fact Sheet. August 24 (updated 7/22/5). Odds Ratio Risk of CDAD According to Antibiotic Class Cephalosporins Fluoroquinolones Clindamycin Macrolides Loo VG, et al. N Engl J Med. 25;353: Fluoroquinolones as Risk Factor for CDAD Retrospective cohort study during an epidemic in Quebec 293 incident cases of CDAD 5.5% of patients were 8 years old 63.5% received fluoroquinolones 21.8% died within 3 days of diagnosis Fluoroquinolones identified as most important risk factor for CDAD during large epidemic (adjusted hazard ratio = 3.44) Pépin J, et al. Clin Infect Dis. 25;41: CDAD and Gastric Acid Suppression Proton pump inhibitors (PPIs) may play a role in development of CDAD although conflicting data exist to date 1-4 Additional studies are required to delineate the mechanism whereby PPIs might increase the risk of CDAD? Gastric acid suppression; gastric acid plays an uncertain role in protection against a spore-forming bacteria that requires only a small inoculum to cause disease? Antibiotic effect of PPIs 1. Dial S, et al. JAMA. 25;294: Yearsley KA, et al. Aliment Pharmacol Ther. 26;24: Lowe DO, et al. Clin Infect Dis. 26;43: Dial S, et al. Can Med Assoc J. 26;175:
2 Severe CDAD in Previously Low-Risk Populations Four States, 25 Recent reports in Northeastern states Young patients otherwise healthy Peripartum women Community-associated Other cases with atypical epidemiology Transmission to close contacts Some without prior antimicrobial and/or hospital exposure Further studies needed to confirm these findings, but clinicians should consider C. difficile testing in patients with diarrhea and without the usual risk factors Diagnosis of CDAD Clinical suspicion Commonly used laboratory tests Toxin testing Antigen detection assays Stool cultures (rarely) Diagnostic imaging Colonoscopy Abdominal computed tomography (CT) scan Chernak E, et al. MMWR Weekly. December 2, 25;54: Principles of Diagnostic Testing Collection of 1 or 2 specimens is sufficient 1 Do not retest after positive result Current laboratory testing Immunoassays have reduced sensitivity (65% to 85%) compared with cytotoxin assay 2 Many tests do not detect toxin A, B + strains Clinical suspicion overrides negative results Monitor clinical response not repeat testing Test of cure assays discouraged 1. Gerding DN, et al. Infect Control Hosp Epidemiol. 1995;16: Poutanen SM, et al. Can Med Assoc J. 24;171: Diagnostic Tools Advantages and Disadvantages Test Advantage(s) Disadvantage(s) Toxin testing Enzyme immunoassay Tissue culture Same-day test; detects toxin A, or A and B More sensitive than enzyme immunoassay Less sensitive than tissue culture cytotoxicity assay Detects toxins A and B; is costly; requires hours for a final result Antigen detection Rapid tests (<1 hour) Must be combined with toxin testing to verify diagnosis; may prove useful as screening tool Stool culture Most sensitive test available when performed appropriately * Due to presence of nontoxigenic strains. CDC Fact Sheet. August 24 (updated 7/22/5). Most often associated with falsepositive results*; labor-intensive; requires hours for results National Hospital Discharge Survey Estimates of short-stay hospital discharges with C. difficile listed as primary or any diagnosis Clostridium difficile: Changing Epidemiology From McDonald LC, et al. Emerg Infect Dis. 26;12:49-415; with permission.
3 Fulminant C. difficile-associated Disease (CDAD) in Pittsburgh Outbreaks: CDAD in Quebec by Age From Dallal RM, et al. Ann Surg. 22;3: ; with permission. From Pépin J, et al. Can Med Assoc J. 24;171: ; with permission. Explanations for the Changing Epidemiology Possibly caused by changes in 1 Antimicrobial use Other drug prescribing practices Infection control practices Emergence of a new strain of C. difficile 1 Increased virulence Antimicrobial resistance Aging of the hospital inpatient population 2 1. McDonald LC. Infect Control Hosp Epidemiol. 25;26: US Department of Health and Human Services. healthworkforce/reports/changedemo/aging.htm. Accessed December 21, 25. Emergence of an Epidemic Strain of C. difficile in the United States, 2-23 Outbreaks occurred in 6 states Epidemic strain was predominant (REA group BI and PFGE type NAP1) Previously uncommon strain with putative virulence factors has become epidemic Development of greater fluoroquinolone resistance may have provided selective advantage that promoted widespread dissemination McDonald LC, et al. N Engl J Med. 25;353: States with the Epidemic Strain of C. difficile Confirmed by CDC and Hines VA Labs (N=27) Updated April 3, 27 AK HI PR DC 27 States confirmed by CDC and/or Hines VA C difficile Research Lab Epidemic Strain Appears to produce greater quantities of toxins A and B 1,2 Has a tcdc gene deletion 2 Is highly resistant to fluoroquinolones 3,4 Binary toxin genes are present Various methods of classification 2,5 Toxinotype III BI (restriction endonuclease analysis [REA]) NAP1 (pulsed-field gel electrophoresis [PFGE]) Ribotype 27 (polymerase chain reaction [PCR]) Pulsovar A (PFGE, Quebec) 1. CDC Fact Sheet. July Warny M, et al. Lancet. 25;366: McDonald LC, et al. 42nd Annual Meeting of IDSA; 24. Abstract LB McDonald LC, et al. N Engl J Med. 25;353: Hubert B, et al. Clin Infect Dis. 27;44:
4 In Vitro Production of Toxins in Epidemic Strain Possible Virulence Factors: Epidemic Strain Hypothesis From Warny M, et al. Lancet. 25;366:79-84; with permission. Adapted from McDonald LC, et al. N Engl J Med. 25;353: ; with permission. Fluoroquinolone Resistance in Epidemic Strains and Controls Epidemiology of CDAD in Quebec Risk for Death and Severe CDAD According to Presence or Absence of Binary Toxin Genes and Partial tcdc Deletion in the Infecting C. difficile Strain Agent Current BI/NAP1 Isolates (n=24) Current Non- Epidemic Isolates (n=24) P-Value* Historic BI/NAP1 Isolates (n=14) P-Value Gatifloxacin 24 (%) (42%) <.1 <.1 Moxifloxacin 24 (%) (42%) <.1 <.1 Percentage OR 1.7 OR 2.1 * P-value for the comparison between BI/NAP1 and non-bi/nap1 isolates. P-value for the comparison between current and historic BI/NAP1 isolates. 2 CDAD deaths Severe CDAD Absent Present Adapted from McDonald LC, et al. N Engl J Med. 25;353: ; with permission. Hubert B, et al. Clin Infect Dis. 27;44: Treatment of CDAD Initial treatment options Metronidazole* Vancomycin Adjunctive therapies Rifampin* Probiotics* Immunoglobulin (IVIG)* Fecal transplantation *Not FDA-approved for the treatment of CDAD. Initial Treatment Options Metronidazole Vancomycin Oral administration preferred 5 mg PO TID for 14 days Historical first-line agent Effective in enteral (oral or rectal) form only 125 mg PO QID for 14 days Typically reserved for severe disease PO=orally; QID=four times a day; TID=three times daily. Fekety R. Am J Gastroenterol. 1997;92: Gerding DN, et al. Infect Control Hosp Epidemiol. 1995;16: ASHP. Am J Health-Syst Pharm. 1998;55:
5 Historical Response to Initial Treatment Agent Response Rate* Relapse Rate Time to Resolution Metronidazole 94-95% 5-16% days Vancomycin 94 - % 15-16% days Recent Observational Reports of Response of C. difficile-associated Infection to Metronidazole Therapy 1 Reference Response Rate Relapse Rate Fernandez A, et al. J Clin Gastroenterol. 24;38: /99 (62%) *Successful treatment of the initial episode of C. difficile-associated disease. Johnson SJ, Gerding DN. Clostridium difficile. In: Antimicrobial Therapy & Vaccines. 2nd edition. Yu V, et al., eds. New York: Apple Trees Productions; 22. Musher DM, et al. Clin Infect Dis. 25;4: Pépin J, et al. Clin Infect Dis. 25;4: /27 (78%) 47/161 (29%) 323/435 (74%) 9/323 (34%) Markers of Severe Disease Marked leukocytosis Colonic thickening on CT scan Ascites on CT scan Pseudomembranes on endoscopy Hemodynamic instability Severe abdominal distension, pain Oral Vancomycin vs Metronidazole in Severe CDAD Prospective, randomized, double-blind, placebocontrolled trial Vancomycin 125 mg PO QID x days vs Metronidazole 25 mg PO QID x days Patients stratified by disease severity Severe disease defined as admission to an ICU, presence of pseudomembranes on endoscopy, or 2 of the following Age > 6 years Temperature > 1 F Albumin level < 2.5 mg/dl White blood cell count > 15, cell/mm 3 Zar FA, et al. Clin Infect Dis. 27;45:August 1 [Epub ahead of print]. Oral Vancomycin vs Metronidazole in Severe CDAD 172 patients enrolled and 15 completed the trial Percent of Patients Mild CDAD (n=81) 9 98 Metronidazole Vancomcyin P = NS 2 Success Failure Zar FA, et al. Clin Infect Dis. 27;45:August 1 [Epub ahead of print]. Percent of Patients Severe CDAD (n=69) Metronidazole Vancomcyin P =.2 3 Success Failure Multiple Recurrent CDAD Rates of recurrent CDAD 2% after first episode 45% after first recurrence 65% after 2 or more recurrences Antibiotic resistance after treatment not reported Repeated, prolonged courses of metronidazole not recommended Several empirical approaches have been advocated but most have no controlled data McFarland LV, et al. Am J Gastroenterol. 22:97:
6 Multiple Recurrent CDAD: Vancomycin Taper Regimen Oral Vancomycin Taper 125 mg QID x 7 days 125 mg BID x 7 days 125 mg daily x 7 days 125 mg every other day x 7 days 125 mg every 3 days x 7 days Kyne L, Kelly CP. Gut. 21;49: Infection Control Preventive Measures Infection Control Measure 1. Malamou-Ladas H, et al. J Clin Pathol. 1988;6: McFarland LV, et al. N Engl J Med. 1989;32: Bettin K, et al. Infect Control Hosp Epidemiol. 1994; 15: Bender BS, et al. Lancet. 1986;ii: Nolan NPM, et al. Gut. 1987;28: Olson M, et al. Infect Control Hosp Epidemiol. 1994; 15: Struelens MJ, et al. Am J Med. 1991;91:138S-144S. Intervention Efficacy Barrier precautions Gloves 1 Proven Hand-washing 2,3 Probable Private room/isolation 4-6 Probable Environmental cleansing Rooms 7-9 Possible Commodes Untested Single-use rectal thermometers Proven Endoscope disinfection 11,12 Probable Other Antibiotic restriction 13,14 Proven Metronidazole for asymptomatic carriers 4,15 Ineffective Adapted from Gerding DN, et al. Infect Control Hosp Epidemiol. 1995;16: ; with permission. 8. Kaatz GW, et al. Am J Epidemiol. 1998;127: Delmee M, et al. Eur J Clin Microbiol. 1987;6: Brooks SE, et al. Infect Control Hosp Epidemiol. 1992;13: Hughes CE, et al. Gastrointest Endosc. 1986;32: Rutala WA, et al. Infect Control Hosp Epidemiol. 1993;14: Pear S, et al. Ann Intern Med. 1994;12: Brown E, et al. Infect Control Hosp Epidemiol. 199;11; Johnson S, et al. Ann Intern Med. 1992;117: Summary Incidence is increasing Epidemic strain has been identified Optimal method of treating complicated C. difficile-associated disease is unknown Standard regimens may not be useful for severe or multiple recurrent disease Control measures prevent transmission.3.5 p q Y Chromosome Gitschier, J., Science, 1993 (261) p. 679 Testis Determining Factor (TDF) Gadgetry (MAC- locus) Channel Flipping (FLP) Catching and Throwing (BLZ-1) Self-confidence (BLZ-2) (note: unlinked to ability) Ability to remember and tell jokes (GOT-1) Sports Page (BUD-E) Addiction to death & destruction movies (MOV-E) Air Guitar (RIF) Ability to identify aircraft (DC) Pre-adolescent fascination with Arachnid and Reptilia (MOM-4U) Spitting (P2E) Sitting on the john reading (SIT) Inability to express emotion over the phone (ME-2) Selective hearing loss (HUH?) Total lack of recall for dates (OOPS)
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
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 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 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 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 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 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 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: 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 informationEd J. Kuijper National Reference Laboratory for Clostridium difficile Leiden University Medical Center
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
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 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 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 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 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 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 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 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 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 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 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 informationAlfonso Torress-Cook, Dr.P.H. Director of Epidemiology/Patient Safety Pacific Hospital of Long Beach
Alfonso Torress-Cook, Dr.P.H. Director of Epidemiology/Patient Safety Pacific Hospital of Long Beach Historical overview The myriad causes of hospital acquired diarrhea Microbiology and ecology of Clostridium
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 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 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 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 informationANTIMICROBIAL THERAPY AND CLOSTRIDIUM DIFFICILE INFECTION
ANTIMICROBIAL THERAPY AND CLOSTRIDIUM DIFFICILE INFECTION 1 Olariu T, 1* Nicolescu A, 2 Chiorean A, 3 Dunca E, 4 Negru D, Olariu I 1 Vasile Goldis Western University of Arad, Department of Intensive Care,
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 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 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 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 informationFlorida Health Care Association District 2 January 13, 2015 A.C. Burke, MA, CIC
Florida Health Care Association District 2 January 13, 2015 A.C. Burke, MA, CIC 11/20/2014 1 To describe carbapenem-resistant Enterobacteriaceae. To identify laboratory detection standards for carbapenem-resistant
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 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 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 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 informationTreatment of Clostridium difficile-associated Diarrhea in the Era of Hypervirulence and Antibiotic Resistance
Review Article Vol. 24 No. 3 Treatment of C. difficile in the era of hypervirulence:- Apisarnthanarak A & Mundy LM. 151 Treatment of Clostridium difficile-associated Diarrhea in the Era of Hypervirulence
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 informationUPDATES IN INFECTIOUS DISEASES
Disclosures UPDATES IN INFECTIOUS DISEASES Nothing to disclose Jacob Kesner, PharmD Lovelace Medical Center Albuquerque, NM 2018 NMSHP Balloon Fiesta Symposium Objectives Outline Pharmacist: 1. Recall
More informationUPDATES IN INFECTIOUS DISEASES
UPDATES IN INFECTIOUS DISEASES Jacob Kesner, PharmD Lovelace Medical Center Albuquerque, NM 2018 NMSHP Balloon Fiesta Symposium Disclosures Nothing to disclose 1 Objectives Pharmacist: 1. Recall infectious
More information11/22/2016. Hospital-acquired Infections Update Disclosures. Outline. No conflicts of interest to disclose. Hot topics:
Hospital-acquired Infections 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 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 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 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 information2010 ARO/CDI Prevalence Survey. MRSA [ ] VRE [ ] Clostridium difficile [ ]
2010 ARO/CDI Prevalence Survey 1) Patient identifier: 2) Hospital number: 3) Is the patient currently (day of survey) infected or colonized with (check all that apply): MRSA [ ] VRE [ ] Clostridium difficile
More informationPneumonia considerations Galia Rahav Infectious diseases unit Sheba medical center
Pneumonia considerations 2017 Galia Rahav Infectious diseases unit Sheba medical center Sir William Osler (1849 1919) "Father of modern medicine Pneumonia: The old man's friend The captain of the men of
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 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 informationHosted by Dr. Jon Otter, Guys & St. Thomas Hospital, King s College, London A Webber Training Teleclass 1
Andreas Voss, MD, PhD Professor of Infection Control Radboud University Nijmegen Medical Centre & Canisius-Wilhelmina Hospital Nijmegen, Netherlands Hosted by Dr. Jon O0er Guys & St. Thomas NHS Founda
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 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 informationCumulative Antibiotic Exposures Over Time and the Risk of Clostridium difficile Infection
MAJOR ARTICLE Cumulative Antibiotic Exposures Over Time and the Risk of Clostridium difficile Infection Vanessa Stevens, 1,3,4 Ghinwa Dumyati, 2 Lynn S. Fine, 2 Susan G. Fisher, 3 and Edwin van Wijngaarden
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 informationCa-MRSA Update- Hand Infections. Washington Hand Society September 19, 2007
Ca-MRSA Update- Hand Infections Washington Hand Society September 19, 2007 Resistant Staph. Aureus Late 1940 s -50% S.Aureus resistant to PCN 1957-80/81 strain- of S.A. highly virulent and easily transmissible
More informationScreening programmes for Hospital Acquired Infections
Screening programmes for Hospital Acquired Infections European Diagnostic Manufacturers Association In Vitro Diagnostics Making a real difference in health & life quality June 2007 HAI Facts Every year,
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 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 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 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 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 informationResistant Infections: Superbugs and No Superdrugs
Resistant Infections: To the SNF and Back Elizabeth Hudson, DO, MPH Department of Infectious Diseases Panorama City 9/15/12 Superbugs and No Superdrugs Antibiotics are often taken for granted Changes over
More informationAntibiotic Updates: Part I
Antibiotic Updates: Part I 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 informationImproving Antimicrobial Therapy in Elders. Margo Schilling MD April 2, st Annual Family Physician Refresher Course
Improving Antimicrobial Therapy in Elders Margo Schilling MD April 2, 2014 41 st Annual Family Physician Refresher Course Objectives Distinguish between symptomatic UTI and asymptomatic bacteriuria in
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 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 information(DRAFT) RECOMMENDATIONS FOR THE CONTROL OF MULTI-DRUG RESISTANT GRAM-NEGATIVES: CARBAPENEM RESISTANT ENTEROBACTERIACEAE
(DRAFT) RECOMMENDATIONS FOR THE CONTROL OF MULTI-DRUG RESISTANT GRAM-NEGATIVES: CARBAPENEM RESISTANT ENTEROBACTERIACEAE John Ferguson (Hunter New England, NSW) on behalf of MRGN Task Force Acknowledgement
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 informationToday s Presenter. Objectives. Presented 12/15/16. Think Smart About Antibiotics: Striking a Balance Between Sepsis and CDI
Think Smart About Antibiotics: Today s Presenter Katie Richards 2 Objectives Define antibiotic stewardship Understand upcoming CMS requirements Know the current data on sepsis and CDI Understand why sepsis
More informationNecrotizing Soft Tissue Infections: Emerging Bacterial Resistance
Necrotizing Soft Tissue Infections: Emerging Bacterial Resistance Eileen M. Bulger, MD Professor of Surgery Harborview Medical Center University of Washington Objectives Review definition & diagnostic
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 informationMRSA Control : Belgian policy
MRSA Control : Belgian policy PEN ERY CLI DOT GEN KAN SXT CIP MIN RIF FUC MUP OXA Marc Struelens Service de microbiologie & unité d épidémiologie des maladies infectieuses Université Libre de Bruxelles
More informationAppropriate antimicrobial therapy in HAP: What does this mean?
Appropriate antimicrobial therapy in HAP: What does this mean? Jaehee Lee, M.D. Kyungpook National University Hospital, Korea KNUH since 1907 Presentation outline Empiric antimicrobial choice: right spectrum,
More informationPractical Pearls for Effective Sustainable Stewardship Programs
Practical Pearls for Effective Sustainable Stewardship Programs Promoting Antimicrobial Stewardship Programs in Minnesota Oct. 24 th, 2013 MOA Bloomington, MN Susan Kline, MD, MPH Introduction Lead Physician
More informationAntibiotic Abyss. Discussion Points. MRSA Treatment Guidelines
Antibiotic Abyss Fredrick M. Abrahamian, D.O., FACEP, FIDSA Professor of Medicine UCLA School of Medicine Director of Education Department of Emergency Medicine Olive View-UCLA Medical Center Sylmar, California
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 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 informationPrevalence & Risk Factors For MRSA. For Vets
For Vets General Information Staphylococcus aureus is a Gram-positive, aerobic commensal bacterium of humans that is carried in the anterior nares of approximately 30% of the general population. It is
More informationThe New England Journal of Medicine. Clinical Practice
The New England Journal of Medicine Clinical Practice This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented,
More informationDuration of antibiotic therapy:
Duration of antibiotic therapy: How low can you go? Thomas Holland, MD Hilton Head, SC July 2017 Disclosures Consulting: The Medicines Company, Basilea Pharmaceutica Adjudication committee: Achaogen Grant
More informationThe Impact of meca Gene Testing and Infectious Diseases Pharmacists. Intervention on the Time to Optimal Antimicrobial Therapy for ACCEPTED
JCM Accepts, published online ahead of print on 7 May 2008 J. Clin. Microbiol. doi:10.1128/jcm.00801-08 Copyright 2008, American Society for Microbiology and/or the Listed Authors/Institutions. All Rights
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 information