Association of Medical Microbiology and Infectious Disease Canada treatment practice guidelines for <i>Clostridium difficile</i> infection

Loo, Vivian G.; Davis, Ian; Embil, John M.; Evans, Gerald A.; Hota, Susy; Lee, Christine; Lee, Todd C.; Longtin, Yves; Louie, Thomas; Martin, Paul; Poutanen, Susan M.; Simor, Andrew E.; Steiner, Theodore S.; Thampi, Nisha; Valiquette, Louis

doi:10.3138/jammi.2018.02.13

Cited by 19 publications

(37 citation statements)

References 133 publications

(177 reference statements)

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“…Information on rates of AMU within specific hospital wards and within specific patient populations will help inform stewardship efforts. Oral vancomycin was used 2.3 times more frequently in ICUs compared to non-ICU wards; this is likely related to higher rates of severe CDI in ICUs [31].…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial use among adult inpatients at hospital sites within the Canadian Nosocomial Infection Surveillance Program: 2009 to 2016

Rudnick

Science

Thirion

et al. 2020

Antimicrob Resist Infect Control

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Background: Antimicrobial resistance is a growing threat to the world's ability to prevent and treat infections. Links between quantitative antibiotic use and the emergence of bacterial resistance are well documented. This study presents benchmark antimicrobial use (AMU) rates for inpatient adult populations in acute-care hospitals across Canada. Methods: In this retrospective surveillance study, acute-care adult hospitals participating in the Canadian Nosocomial Infection Surveillance Program (CNISP) submitted annual AMU data on all systemic antimicrobials from 2009 to 2016. Information specific to intensive care units (ICUs) and non-ICU wards were available for 2014-2016. Data were analyzed using defined daily doses (DDD) per 1000 patient days (DDD/1000pd). Results: Between 2009 and 2016, 16-18 CNISP adult hospitals participated each year and provided their AMU data (22 hospitals participated in ≥1 year of surveillance; 11 in all years). From 2009 to 2016, there was a significant reduction in use (12%) (from 654 to 573 DDD/1000pd, p = 0.03). Fluoroquinolones accounted for the majority of this decrease (47% reduction in combined oral and intravenous use, from 129 to 68 DDD/1000pd, p < 0.002). The top five antimicrobials used in 2016 were cefazolin (78 DDD/1000pd), piperacillin-tazobactam (53 DDD/1000pd), ceftriaxone (49 DDD/1000pd), vancomycin (combined oral and intravenous use was 44 DDD/1000pd; 7% of vancomycin use was oral), and ciprofloxacin (combined oral and intravenous use: 42 DDD/1000pd). Among the top 10 antimicrobials used in 2016, ciprofloxacin and metronidazole use decreased significantly between 2009 and 2016 by 46% (p = 0.002) and 26% (p = 0.002) respectively. Ceftriaxone (85% increase, p = 0.0008) and oral amoxicillin-clavulanate (140% increase, p < 0.0001) use increased significantly but contributed only a small component (8.6 and 5.0%, respectively) of overall use.

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Section: Discussionmentioning

confidence: 99%

Antimicrobial use among adult inpatients at hospital sites within the Canadian Nosocomial Infection Surveillance Program: 2009 to 2016

Rudnick

Science

Thirion

et al. 2020

Antimicrob Resist Infect Control

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“…IDSA/SHEA further defines severe CDI as CDI with presence of a white blood cell count (> 15,000 per microliter) or serum creatinine of >1.5 mg/dL. 3,25 Other guidelines add fever, presence of ICU admission, endoscopically visualized pseu-domembranes, abdominal pain, hypoalbuminemia (serum albumin <3 g/dL), or age 65 years as indicators of severe disease. 26,27 Progression from severe to fulminant CDI, also termed "severe and complicated" CDI, includes development of shock, ileus, and/or megacolon.…”

Section: Severe CDImentioning

confidence: 99%

Clostridium difficile Infection: An Epidemiology Update

Roo

Regenbogen

2020

Clinics in Colon and Rectal Surgery

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Clostridium (reclassified as “Clostridioides”) difficile infection (CDI) is a healthcare-associated infection and significant source of potentially preventable morbidity, recurrence, and death, particularly among hospitalized older adults. Additional risk factors include antibiotic use and severe underlying illness. The increasing prevalence of community-associated CDI is gaining recognition as a novel source of morbidity in previously healthy patients. Even after recovery from initial infection, patients remain at risk for recurrence or reinfection with a new strain. Some pharmaco-epidemiologic studies have suggested an increased risk associated with proton pump inhibitors and protective effect from statins, but these findings have not been uniformly reproduced in all studies. Certain ribotypes of C. difficile, including the BI/NAP1/027, 106, and 018, are associated with increased antibiotic resistance and potential for higher morbidity and mortality. CDI remains a high-morbidity healthcare-associated infection, and better understanding of ribotypes and medication risk factors could help to target treatment, particularly for patients with high recurrence risk.

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“…Some prominent authors and scientific societies such as the SHEA, the Association for Professionals in Infection Control and Epidemiology, the CDC, the Healthcare Infection Control Practices Advisory Committee, and comycin or fidaxomicin. A recent prospective, multicenter study demonstrated that courses with either antibiotic resulted in similar treatment outcomes for patients afflicted with severe CDI [21,162]. When oral treatment is not possible, intravenous metronidazole should be used.…”

Section: Question 9 When and How To Report Clinicians The Results Ofmentioning

confidence: 99%

“…As we previously concluded in question 11, recent literature and guidelines have implicitly agreed that metronidazole should be dismissed as an alternative for the treatment of CDI, even in non-severe cases [21,162]. In fact, the current approach for treating a first episode of CDI should not be based on the severity of the first episode but instead should be based on the presence or not of risk factors for CDI recurrence (figure 3).…”

Section: Question 20 How Should a Patient With A First Episode Of CDmentioning

confidence: 99%

Recommendations for the diagnosis and treatment of Clostridioides difficile infection: An official clinical practice guideline of the Spanish Society of Chemotherapy (SEQ), Spaish Society of Internal Medicine (SEMI) and the working group of Postoperative Infection of the Spanish Society of Anesthesia and Reanimation (SEDAR)

Bouza¹,

Aguado²,

Alcalá³

et al. 2020

Rev Esp Quimioter

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ned leukocytosis, even in the absence of classical risk factors. With a few exceptions, a single stool sample is sufficient for diagnosis, which can be sent to the laboratory with or without transportation media for enteropathogenic bacteria. In the absence of diarrhoea, rectal swabs may be valid. The microbiology laboratory should include C. difficile among the pathogens routinely searched in patients with diarrhoea. Laboratory tests in different order and sequence schemes include GDH detection, presence of toxins, molecular tests and toxigenic culture. Immediate determination of sensitivity to drugs such as vancomycin, metronidazole or fidaxomycin is not required. The evolution of toxin persistence is not a suitable test for follow up. Laboratory diagnosis of CDI should be rapid and results reported and interpreted to clinicians immediately. In addition to the basic support of all diarrheic episodes, CDI treatment requires the suppression of antiperistaltic

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Association of Medical Microbiology and Infectious Disease Canada treatment practice guidelines for Clostridium difficile infection

Cited by 19 publications

References 133 publications

Antimicrobial use among adult inpatients at hospital sites within the Canadian Nosocomial Infection Surveillance Program: 2009 to 2016

Antimicrobial use among adult inpatients at hospital sites within the Canadian Nosocomial Infection Surveillance Program: 2009 to 2016

Clostridium difficile Infection: An Epidemiology Update

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