Clostridium difficile infection (CDI) is associated with high mortality. Reducing incidence is a priority for patients, clinicians, the National Health Service (NHS) and Public Health England alike. In June 2012, fidaxomicin (FDX) was launched for the treatment of adults with CDI. The objective of this evaluation was to collect robust real-world data to understand the effectiveness of FDX in routine practice. In seven hospitals introducing FDX between July 2012 and July 2013, data were collected retrospectively from medical records on CDI episodes occurring 12 months before/after the introduction of FDX. All hospitalised patients aged ≥18 years with primary CDI (diarrhoea with presence of toxin A/B without a previous CDI in the previous 3 months) were included. Recurrence was defined as in-patient diarrhoea re-emergence requiring treatment any time within 3 months after the first episode. Each hospital had a different protocol for the use of FDX. In hospitals A and B, where FDX was used first line for all primary and recurrent episodes, the recurrence rate reduced from 10.6 % to 3.1 % and from 16.3 % to 3.1 %, with a significant difference in 28-day mortality from 18.2 % to 3.1 % (p < 0.05) and 17.3 % to 6.3 % (p < 0.05) for hospitals A and B, respectively. In hospitals using FDX in selected patients only, the changes in recurrence rates and mortality were less marked. The pattern of adoption of FDX appears to affect its impact on CDI outcome, with maximum reduction in recurrence and all-cause mortality where it is used as first-line treatment.

PurposeCommunity-acquired pneumonia (CAP) due to Streptococcus pneumoniae continues to represent a major public health problem. Despite the availability of a safe and effective vaccine, it is underutilized by the medical community. Given that up to two thirds of patients with serious pneumococcal disease have been hospitalized within 4 years of their illness, the acute care hospital stay represents an opportunity for vaccination. Although The Center for Medicaid and Medicare Services (CMS) requires public reporting of pneumococcal vaccination rates for patients admitted with pneumonia, few data exist as to how hospital personnel can improve their performance in achieving adequate rates of vaccination. We report our experience of a stepwise program to improve vaccination rates in hospitalized patients with CAP.MethodsThe Medical University of South Carolina Medical Center used chart review to assess vaccination status on all patients admitted with a primary diagnosis of CAP. The education portion of the program, consisting of barrier determination and literature reviews, was initiated at the physician and nurse level in July 2001. In September 2001, a nursing assessment form was initiated with subsequent quarterly feedback to nurses and physicians regarding vaccination rates. In January 2003, a standing order form was initiated. Administrative leadership support was provided throughout the program.SummaryVaccination rates improved steadily each quarter after the initiation of the program. Baseline vaccination rates were only 4% for patients admitted with CAP. After the initiation of education strategies in July 2001, vaccination rates increased to 33% by 3rd quarter 2001. After the initiation of the nurse assessment form in September 2001, vaccination rates increased to 71% by 4th quarter 2002. After the initiation of the standing order program in January 2003, vaccination rates increased to 95% by 1st quarter 2004. Second quarter preliminary rates have remained > 95% (preliminary data 100%).ConclusionsOur medical center used a multistep approach to attain vaccination rates in compliance with federal guidelines. We first initiated physician and nursing education strategies, then added a nursing assessment form in the medical records. This was followed by data feedback at the physician and nurse levels, and finally by the institution of a standing orders program. We found remarkable success with this multistep program and recommend it to other medical centers.

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