Managing Clostridium difficile infection in hospitalised patients

Denton, Andrea; Topping, Annie; Humphreys, Paul

doi:10.7748/ns2014.04.28.33.37.e8461

Cited by 3 publications

(4 citation statements)

References 22 publications

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“…In addition, laboratories within and across countries can apply diverse testing strategies due to different guidelines [( 20 , 22 ) Int2–3, 5, 7] and so there is a lack of standardized practice. There are also both advantages and disadvantages to individual diagnostic tools, related to accuracy, turnaround time and distinguishing colonization from toxigenic infection [( 2 , 4 , 16 , 20 , 21 , 23 , 24 ), Int2–3].…”

Section: Resultsmentioning

confidence: 99%

Improving care for patients with Clostridioides difficile infection: A clinical practice and healthcare systems perspective

et al. 2023

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IntroductionArriving at a C. difficile infection (CDI) diagnosis, treating patients and dealing with recurrences is not straightforward, but a comprehensive and well-rounded understanding of what is needed to improve patient care is lacking. This manuscript addresses the paucity of multidisciplinary perspectives that consider clinical practice related and healthcare system-related challenges to optimizing care delivery.MethodsWe draw on narrative review, consultations with clinical experts and patient representatives, and a survey of 95 clinical and microbiology experts from the UK, France, Italy, Australia and Canada, adding novel multi-method evidence to the knowledge base.Results and discussionWe examine the patient pathway and variations in clinical practice and identify, synthesize insights on and discuss associated challenges. Examples of key challenges include the need to conduct multiple tests for a conclusive diagnosis, treatment side-effects, the cost of some antibiotics and barriers to access of fecal microbiota transplantation, difficulties in distinguishing recurrence from new infection, workforce capacity constraints to effective monitoring of patients on treatment and of recurrence, and ascertaining whether a patient has been cured. We also identify key opportunities and priorities for improving patient care that target both clinical practice and the wider healthcare system. While there is some variety across surveyed countries’ healthcare systems, there is also strong agreement on some priorities. Key improvement actions seen as priorities by at least half of survey respondents in at least three of the five surveyed countries include: developing innovative products for both preventing (Canada, Australia, UK, Italy, and France) and treating (Canada, Australia, and Italy) recurrences; facilitating more multidisciplinary patient care (UK, Australia, and France); updating diagnosis and treatment guidelines (Australia, Canada, and UK); and educating and supporting professionals in primary care (Italy, UK, Canada, and Australia) and those in secondary care who are not CDI experts (Italy, Australia, and France) on identifying symptoms and managing patients. Finally, we discuss key evidence gaps for a future research agenda.

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Section: Resultsmentioning

confidence: 99%

Improving care for patients with Clostridioides difficile infection: A clinical practice and healthcare systems perspective

et al. 2023

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“…At the time of the study there were formal mechanisms in place for feedback of the audit and monitoring tool as can be seen from figure 3. 8 There was however no formal feedback mechanism to the matron or ward manager. One of the recommendations from the study was to explore the benefits of providing formal feedback to the ward manager through weekly or monthly summaries.…”

Section: Discussionmentioning

confidence: 99%

“…The assessment was undertaken on a daily basis for all inpatients with CDI by an Infection Prevention and Control Practitioner (IPCP) and the Matron responsible for the ward area in conjunction with ward based staff. The original AMT 8 is shown in table i.…”

Section: Introductionmentioning

confidence: 99%

Evolution of an audit and monitoring tool into an infection prevention and control process

Denton

Topping

Humphreys

2016

Journal of Hospital Infection

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The use of auditing and monitoring tools as part of a daily review process may enable ward staff, matrons, and IPCPs to improve patient outcomes and achieve the required levels of environmental hygiene if they act as a focal point for interaction, education, and collaboration. The findings offer insights into the behavioural changes and improved patient outcomes that ensue from the implementation of a DRP.

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“…68 While non-professional home-based caregivers are frequently relied upon for providing medication to patients with dementia, the extra care requirements for effectively managing the spread of infection (both in terms of equipment and personal hygiene/care) may also require additional support that is not typically covered by health insurance. 69 The challenges of filling the prescription soon after discharge and then administering it successfully over a prolonged period demonstrate why patients (and their caregivers) may prefer a single round of FMT treatment in the hospital.…”

Section: A Clinical Ethicsmentioning

confidence: 99%

The Ethics of Fecal Microbiota Transplant as a Tool for Antimicrobial Stewardship Programs

Murray¹,

Herbst²

2019

J. Law. Med. Ethics

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Multidrug resistant organisms (MDROs) are a public health threat that have reduced the effectiveness of many available antibiotics. Antimicrobial stewardship programs (ASPs) have been tasked with reducing antibiotic use and therefore the emergence of MDROs. While fecal microbiota transplant (FMT) has been proposed as therapy to reduce patient colonization of MDROs, this will require additional evidence to support an expansion of the current clinical indication for FMT. This article discusses the evidence and ethics of the expanded utilization of FMT by ASPs for reasons other than severe recurrent or refractory Clostridioides (formerly Clostridium) difficile infection.

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Managing Clostridium difficile infection in hospitalised patients

Cited by 3 publications

References 22 publications

Improving care for patients with Clostridioides difficile infection: A clinical practice and healthcare systems perspective

Improving care for patients with Clostridioides difficile infection: A clinical practice and healthcare systems perspective

Evolution of an audit and monitoring tool into an infection prevention and control process

The Ethics of Fecal Microbiota Transplant as a Tool for Antimicrobial Stewardship Programs

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