Changes in treatment of community-onset Clostridioides difficile infection after release of updated guidelines, Atlanta, Georgia, 2018

Adelman, Max W.; Goodenough, Dana; Sefton, Samantha; Mackey, Carolyn; Thomas, Stepy; Fridkin, Scott K.; Woodworth, Michael H.

doi:10.1016/j.anaerobe.2021.102364

Cited by 3 publications

(3 citation statements)

References 11 publications

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“…Likewise, some studies from Western countries after update of guidelines just exactly supported this condition. 38,39 The strength of this study is that it is a multicenter survey in Asia. The results of this study provide an overview of the current status of opportunistic infection in IBD, which may guide future practice.…”

Section: Discussionmentioning

confidence: 99%

Current Status of Opportunistic Infection in Inflammatory Bowel Disease Patients in Asia: A Questionnaire-Based Multicenter Study

et al. 2022

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Background/Aims: Opportunistic infection in inflammatory bowel disease (IBD) has become a serious problem. However, its status of doctors' opinions and test equipment in hospitals are unclear. The aim of the study was to investigate these issues to improve the prognosis of IBD patients.Methods: This retrospective, multicenter study was conducted by 83 investigators who were members of the Asian Organization for Crohn's and Colitis. Data on opportunistic infection were collected from hospital databases between January 2017 and December 2017. The survey consisted of 11 items.Results: Most physicians appreciated the diagnostic value of tissue cytomegalovirus (CMV) DNA, accounting for 86.1% of members in China, 37.5% in Japan, 52.9% in South Korea, and 66.7% in Southeast Asia. Only 83.1% of hos pitals had the ability to test for CMV immunohistochemistry in Asia. Hepatitis B surface antigen (HBsAg) screening was recommended by all members. However, only 66.7% in China, 70.6% in South Korea, and 66.7% in Southeast Asia agreed to routinely vaccinate IBD patients when HBsAg tested negative. Most members preferred metronidazole (74.7%) as the first choice for patients with Clostridium difficile infection. However, the proportion of stool C. difficile toxin test was lower in China than in other areas (75.0% in China vs 95.8% in Japan and 100% in South Korea and Southeast Asia, p<0.05). Conclusions: Opportunistic infection from CMV, hepatitis B virus, and C. difficile should be of high concern for IBD patients. More efforts are needed, such as understanding consensus in clinical practice and improving testing facilities in hospitals. (Gut Liver 2022;16:726-735

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Section: Discussionmentioning

confidence: 99%

Current Status of Opportunistic Infection in Inflammatory Bowel Disease Patients in Asia: A Questionnaire-Based Multicenter Study

et al. 2022

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“…2 In another study of community-onset CDI, metronidazole was still used in nearly 25% of cases. 3 In an earlier UPMC review, oral vancomycin and fidaxomicin use increased and oral metronidazole slightly decreased after our institutional guidelines changed, 4 but fidaxomicin use remained low compared to oral vancomycin. To better understand fidaxomicin prescribing at UPMC after our guideline change, we evaluated fidaxomicin orders from 10 community hospitals with limited on-site antimicrobial stewardship programs.…”

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confidence: 96%

“…Previous studies have evaluated the impact of IDSA/SHEA guidelines on CDI treatment. 2,3 One outpatient prescription review found oral vancomycin and fidaxomicin use significantly increased while metronidazole use decreased following publication of the revised guidelines. 2 In another study of community-onset CDI, metronidazole was still used in nearly 25% of cases.…”

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confidence: 99%

Evaluation of fidaxomicin use in community hospitals after a clinical guideline change at a large health system and opportunities for stewardship

Khadem

Nguyen

Bariola

2022

Infect. Control Hosp. Epidemiol.

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After updating our health system’s Clostridioides difficile treatment protocols in 2018, we reviewed 104 unique hospital encounters involving fidaxomicin at 10 community hospitals. Half (50%) of regimens were adherent to our guidelines, with infectious diseases (ID) providers were frequently nonadherent. Antimicrobial stewardship programs are important for facilitating best practices, even among ID specialists.

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Clostridioides difficile Infection among Cirrhotic Patients with Variceal Bleeding

et al. 2021

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Clostridioides difficile infection (CDI) stands as the leading cause of nosocomial infection with high morbidity and mortality rates, causing a major burden on the healthcare system. Driven by antibiotics, it usually affects older patients with chronic disease or immunosuppressed or oncologic management. Variceal bleeding secondary to cirrhosis requires antibiotics to prevent bacterial translocation, and thus patients become susceptible to CDI. We aimed to investigate the risk factors for CDI in cirrhotic patients with variceal bleeding following ceftriaxone and the mortality risk in this patient’s population. We retrospectively screened 367 cirrhotic patients with variceal bleeding, from which 25 patients were confirmed with CDI, from 1 January 2017 to 31 December 2019. We found MELD to be the only multivariate predictor for mortality (odds ratio, OR = 1.281, 95% confidence interval, CI: 0.098–1.643, p = 0.042). A model of four predictors (age, days of admission, Charlson index, Child–Pugh score) was generated (area under the receiver operating characteristics curve, AUC = 0.840, 95% CI: 0.758–0.921, p < 0.0001) to assess the risk of CDI exposure. Determining the probability of getting CDI for cirrhotic patients with variceal bleeding could be a tool for doctors in taking decisions, which could be integrated in sustainable public health programs.

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Changes in treatment of community-onset Clostridioides difficile infection after release of updated guidelines, Atlanta, Georgia, 2018

Cited by 3 publications

References 11 publications

Current Status of Opportunistic Infection in Inflammatory Bowel Disease Patients in Asia: A Questionnaire-Based Multicenter Study

Current Status of Opportunistic Infection in Inflammatory Bowel Disease Patients in Asia: A Questionnaire-Based Multicenter Study

Evaluation of fidaxomicin use in community hospitals after a clinical guideline change at a large health system and opportunities for stewardship

Clostridioides difficile Infection among Cirrhotic Patients with Variceal Bleeding

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