An antibiotic policy associated with reduced risk of Clostridium difficile-associated diarrhoea

Ludlam, H.; Brown, Nicholas M.; Sule, Olajumoke; Redpath, C.; Coni, Nicholas; Owen, G

doi:10.1093/ageing/28.6.578

Cited by 68 publications

(31 citation statements)

References 4 publications

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“…Previous studies usually analyzed low numbers of risk factors, whereas our use of extensive multivariate analysis and two control groups likely increased the accuracy of results. Also, it is clear that CDI risk is not consistent across all broad-spectrum agents (16,22,27,35). It is noteworthy that the risk factors associated with CDI differed from those associated with C. perfringens.…”

Section: Discussionmentioning

confidence: 98%

“…It is recognized that the risk of AAD can be reduced by substituting the administration of high-risk antibiotics, such as broad-spectrum cephalosporins and clindamycin (16), with relatively low-risk drugs such as penicillin, trimethoprim, gentamicin (35), ciprofloxacin (27), and ureidopenicillins (41,47). Identifying additional risk factors for AAD permits interventions to reduce disease burden.…”

Section: Discussionmentioning

confidence: 99%

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Comparative Analysis of Prevalence, Risk Factors, and Molecular Epidemiology of Antibiotic-Associated Diarrhea Due to Clostridium difficile , Clostridium perfringens , and Staphylococcus aureus

Tompkins²,

2006

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We prospectively studied the comparative epidemiology and risk factors for Clostridium difficile, Clostridium perfringens, and Staphylococcus aureus antibiotic-associated diarrhea (AAD). Four thousand six hundred fiftynine inpatient fecal specimens (11 months) were tested for C. difficile cytotoxin, C. perfringens enterotoxin, and S. aureus by Vero cell assay, enzyme-linked immunosorbent assay, and growth on fresh blood agar, respectively. Two distinct age-, sex-, and location-matched control patient groups were used for multivariate logistic regression risk factor analyses: symptomatic patients who were AAD pathogen negative and asymptomatic patients with histories of recent antimicrobial therapy. All AAD pathogen isolates were DNA fingerprinted. In AAD cases, the prevalences of C. difficile cytotoxin, C. perfringens enterotoxin, and S. aureus were 12.7%, 3.3%, and 0.2%, respectively (15.8% overall). Age of >70 years was a common risk factor. Other risk factors for infective AAD and C. difficile AAD included length of hospital stay and use of feeding tubes (length of stay odds ratios [OR], 1.017 and 1.012; feeding tube OR, 1.864 and 2.808). Female gender and use of antacids were significantly associated with increased risk of C. perfringens AAD (OR, 2.08 and 2.789, respectively), but unlike what was found for C. difficile AAD, specific antibiotic classes were not associated with increased risk. A limited number of genotypes caused the majority of C. difficile and C. perfringens AAD cases. Similar to what was found for C. difficile AAD, there was epidemiological evidence of C. perfringens AAD case clustering and reinfection due to different strains. C. difficile AAD was approximately 4 and 60 times more common than C. perfringens AAD and S. aureus AAD, respectively. Risk factors for these AAD pathogens differed, highlighting the need to define specific control measures. There is evidence of nosocomial transmission in cases of C. perfringens AAD.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Comparative Analysis of Prevalence, Risk Factors, and Molecular Epidemiology of Antibiotic-Associated Diarrhea Due to Clostridium difficile , Clostridium perfringens , and Staphylococcus aureus

Tompkins²,

2006

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“…Endemic CDI can be controlled by reducing the use of high risk agents [19][20][21][22], However, changes in incidence of CDI following altered antibiotic prescribing practice have generally been seen in noncomparative settings, and\or have not been tested by reintroduction of the suspected antibiotics. Recently, Stone and Kibbler [23] reported that a fall in incidence of C. difficile diarrhoea in an elderly medicine unit was associated with a reduction in cephalosporin use.…”

Section: Discussionmentioning

confidence: 99%

Molecular epidemiology of endemic Clostridium difficile infection

Fawley

Wilcox

2001

Epidemiol. Infect.

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SUMMARYThis is the first study to provide a comprehensive insight into the molecular epidemiology of endemic Clostridium difficile and particularly that associated with a recently recognized epidemic strain. We DNA fingerprinted all C. difficile isolates from the stools of patients with symptomatic antibiotic-associated diarrhoea and from repeated samples of the inanimate ward environment on two elderly medicine hospital wards over a 22-month period. Notably, C. difficile was not recoverable from either ward immediately before opening, but was found on both wards within 1-3 weeks of opening, and the level of environmental contamination rose markedly during the first 6 months of the study period. C. difficile infection (CDI) incidence data correlated significantly with the prevalence of environmental C. difficile on ward B (r l 0n76, P 0n05) but not on ward A (r l 0n26, P 0n05). We found that RAPD and RS-PCR typing had similar discriminatory power, although, despite fingerprinting over 200 C. difficile isolates, we identified only six distinct types. Only two distinct C. difficile strains were identified as causing both patient infection and ward contamination. Attempts to determine whether infected patients or contaminated environments are the prime source for cross-infection by C. difficile had limited success, as over 90 % of C. difficile isolates were the UK epidemic clone. However, a non-epidemic strain caused a cluster of six cases of CDI, but was only isolated from the environment after the sixth patient became symptomatic. The initial absence of this strain from the environment implies patient-to-patient and\or staff-to-patient spread. In general, routine cleaning with detergent was unsuccessful at removing C. difficile from the environment. Understanding the epidemiology and virulence of prevalent strains is important if CDI is to be successfully controlled.

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“…Having said that, a number of studies have demonstrated a relationship between antibiotic restriction 48,[82][83][84][85] or other antimicrobial stewardship policies 32,86 and decreases in nosocomial C difficile infections or disease. Figure 2 illustrates the impact of a nonrestrictive antimicrobial stewardship program at a secondary/tertiary-care hospital in Quebec, Canada, on an epidemic of C difficile-associated disease (CDAD) that occurred at the institution during the latter portion of 2003.…”

Section: Evaluating Antimicrobial Stewardship Programsmentioning

confidence: 99%

Antimicrobial stewardship for inpatient facilities

Ohl

Luther

2011

Journal of Hospital Medicine

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Antibiotic stewardship aims to improve patient care and reduce unwanted consequences of antimicrobial overuse or misuse, including lowered efficacy, emergence of antimicrobial resistance, development of secondary infections, adverse drug reactions, increased length of hospital stay, and additional healthcare costs. Recent guidelines make specific recommendations for the development of institutional programs to enhance antimicrobial stewardship. Optimally, such programs should be comprehensive, multidisciplinary, supported by hospital and medical staff leadership, and should employ evidence‐based strategies that best fit local needs and resources. An infectious diseases physician and clinical pharmacist with infectious diseases training are recommended as core members of the multidisciplinary team, although a hospitalist with interest (and perhaps additional training) in antimicrobial therapy may be able to fill the void. Program directors and core members should be compensated for their time. Principal proactive strategies—with evidence supporting their consideration—include prospective audits, with intervention and feedback, formulary restriction, and preauthorization. Other strategies include persistent one‐on‐one education, guidelines adapted to local needs, and informatics to support clinical decision making. Intervention goals are to prevent unnecessary antimicrobial starts, to streamline or de‐escalate therapy early in its course, and to convert from parenteral to oral therapy, optimize dosing, and ensure the appropriate length of therapy. Most community hospitals, if sufficiently resourced, should be able to implement a successful antimicrobial stewardship program. Evidence suggests that good antimicrobial stewardship can lead to less overall and inappropriate antimicrobial use, lower drug‐related costs, reductions in Clostridium difficile–associated disease, and, in some studies, less emergence of antimicrobial resistance. Journal of Hospital Medicine 2011;6:S4‐S15 ©2011 Society of Hospital Medicine.

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An antibiotic policy associated with reduced risk of Clostridium difficile-associated diarrhoea

Cited by 68 publications

References 4 publications

Comparative Analysis of Prevalence, Risk Factors, and Molecular Epidemiology of Antibiotic-Associated Diarrhea Due to Clostridium difficile , Clostridium perfringens , and Staphylococcus aureus

Comparative Analysis of Prevalence, Risk Factors, and Molecular Epidemiology of Antibiotic-Associated Diarrhea Due to Clostridium difficile , Clostridium perfringens , and Staphylococcus aureus

Molecular epidemiology of endemic Clostridium difficile infection

Antimicrobial stewardship for inpatient facilities

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