Multidisciplinary Approach to Clostridium difficile Infection in Adult Surgical Patients

Turner, Megan C.; Behrens, Shay; Webster, Wendy; Huslage, Kirk; Smith, Becky; Wrenn, Rebekah; Woody, Regina; Mantyh, Christopher R.

doi:10.1016/j.jamcollsurg.2018.12.045

Cited by 12 publications

(6 citation statements)

References 20 publications

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“…On the other hand, the present data were also confirmed by data on CDI epidemiology in Europe as, according to the 2016 ECDC report, the most common CD ribotype, both in Europe and in Poland, was RT027 [6,29]. Unfortunately, epidemic ribotype RT027 is associated with multiple antimicrobial resistance, also to fluoroquinolones [30].…”

Section: Discussionsupporting

confidence: 85%

“…Unfortunately, epidemic ribotype RT027 is associated with multiple antimicrobial resistance, also to fluoroquinolones [30]. Perhaps, the present data also explain the phenomenon described by Pituch et al, concerning the very high proportion of ribotype RT027 in Poland, which was over two-fold higher, 23% vs. 48%, compared to other European data [29]. Currently, fluoroquinolones remain one of the most frequently administered drugs in the treatment of Polish patients and their proportion in outpatient treatment grew significantly from 2007 to 2016 and amounted to 6% of the total antibiotic sales [31].…”

Section: Discussionsupporting

confidence: 80%

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Long-Term Antibiotic Prophylaxis in Urology and High Incidence of Clostridioides difficile Infections in Surgical Adult Patients

et al. 2020

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Clostridioides difficile infections are the main cause of antibiotic-related diarrhea. Most of them come in the form of healthcare-associated Clostridioides difficile infections (HA-CDI). The aim of the study was to analyze HA-CDI epidemiology and the relationship between antibiotic consumption and CDI epidemiology at St Luke’s Provincial Hospital in Tarnow, Poland. In 2012–2018, surveillance of CDI was carried out in adult surgical wards at St Luke’s Provincial Hospital. The data were collected in accordance with the methodology of the Healthcare-Associated Infections Surveillance Network (HAI-Net), European Centre for Disease Prevention and Control (ECDC), and the ATC/DDD system (Anatomical Therapeutic Chemical Classification System) of the World Health Organization. In total, in the study period, 51 cases of CDI involved CA-CDI (24.5%) and 147 were HA-CDIs (75.5%). The most CA-CDIs were found in the general surgery (32.6%) and urology (17.0%) wards. CA-CDI incidence was 0.7/1000 patients and for HA-CDI it was 2/1000 patients (4.4/10,000 patientdays (pds)). The highest HA-CDI incidence was in the neurosurgical departments (18/10,000 pds) and oncological surgery (8.4/10,000) pds. There was a significant positive correlation between CA-CDI and HA-CDI (correlation of 0.943, p < 0.001) and between the number of patients hospitalized and HA-CDI (correlation of 0.865, p = 0.012). The total antibiotic consumption amounted to 0.7 DDD/10,000 pds; it was the highest in the urology ward (0.84/10,000 pds) and 49.5% of the antibiotics were fluoroquinolones (0.41/10,000 pds). On the basis of regression coefficients, a positive correlation was demonstrated between the use of fluoroquinolones and the HA-CDI incidence rate. Both a high percentage of CDI cases and a high intake of antibiotics were recorded in the urology department. About half of all antibiotics were fluoroquinolones.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 80%

Long-Term Antibiotic Prophylaxis in Urology and High Incidence of Clostridioides difficile Infections in Surgical Adult Patients

et al. 2020

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“…In terms of isolation policies for infection control, García-Lecona et al reported that CDI patients in a common isolation unit showed a decreased mortality rate but an increased rate of recurrence than those managed alone 22. Recently, ultraviolet disinfection has been trialed in this context with promising outcomes 23,24. We have not employed this disinfection strategy but a previous study supports its future utilization by our team.…”

Section: Discussionmentioning

confidence: 89%

<p>Interprofessional Antimicrobial Stewardship Influencing <em>Clostridioides difficile</em> Infection: An 8-Year Study Using Antimicrobial Use Density</p>

Yoshida¹,

Kikuchi²,

Ueno³

et al. 2019

IDR

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PurposeTo reduce Clostridioides difficile infection (CDI), we implemented interprofessional antimicrobial, infection control, and diagnostic stewardship (ipAS) conducted by physicians/pharmacists, infection control nurses, and medical technologists, respectively. As a numerical indicator for ipAS, we used antimicrobial use density (AUD) in an 8-year study to validate its efficacy in CDI reduction.Patients and methodsThis was an observational study. CDI was defined as stool samples or C. difficile isolates containing toxin A and/or B from a patient with diarrhea occurring three or more times per day. From 2011–2018 at a 10-ward single site the subjects were in-patients with CDI, and the following data were collected: AUDs for 23 antibiotics, and antimicrobial test results. By 2015, we had established ipAS, consisting of culture submission before the administration of broad-spectrum antimicrobials, the promotion of point-of-care testing for diagnosis-based antimicrobials, perioperative prophylactic antibiotics, intervention at positive diagnosis of blood culture, team round for diarrhea, and inspection on contact precautions and disinfection in CDI cases. The study outcomes included annual numbers of CDI patients and blood culture sets. We compared annual AUDs between former (2011–14) and latter (2015–18) periods using Kruskal–Wallis tests and examined the correlation between AUDs and CDI numbers.ResultsOf a total 50,970 patients, 1,750 patients underwent C. difficile toxin tests, of whom 171 patients (9.8%) were positive for CDI. Between the former and latter periods, AUDs for flomoxef (11.96 to 2.71 by medians), panipenem/betamipron (0.30 to 0.00), and clindamycin (3.87 to 2.19) significantly decreased (P<0.05) as did numbers of CDIs (26.5 to 10) (P=0.043). The correlation analysis revealed a significant correlation between AUD for flomoxef and CDIs (P=0.004) and the AUD for piperacillin/tazobactam and CDIs (P=0.010) with a positive Pearson r.ConclusionThe integrated antimicrobial, diagnostic, and infection control approach used in ipAS may reduce CDIs.

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“…Cleaning of patient rooms with ultraviolet disinfectant light may be useful. 29 Minimizing the use of proton pump inhibitors and unnecessary antibiotic exposure may help reduce the rate of CDI occurrence. 30,31 With a very high probability of postoperative C. difficile infection, the use of prophylactic probiotics and prophylactic antibiotics such as metronidazole or oral vancomycin could be a potential preventive measure, but these preventive strategies require further study to assess their efficacy and safety 32 .…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of a web-based Postoperative Clostridioides difficile infection risk prediction model

Woo

Hess

Ackermann

et al. 2020

Preprint

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Background: Clostridioides difficile infection is associated with significant morbidity, mortality and increased costs. Assessment of the postoperative C. difficile infection risk is necessary to improve the outcome of surgical patients. Objective: To develop and validate a risk prediction tool for C. difficile infection after surgery. Methods: In this retrospective cohort study, 2,451,169 surgical patients from the American College of Surgeons National Surgical Quality Improvement Program Database (ACS-NSQIP) over 2015-2017 were included. Nine predictors were selected for the model: age, preoperative leukocytosis >12,000 (cells/μL), hematocrit (≤30%), chronic dialysis, insulin dependent diabetes, weight loss, steroid use, presence of preoperative sepsis, and surgery type. A second model included hospital length of stay as a predictor. A predictive model was developed using ACS-NSQIP 2015-2016 training cohort (n=1,435,157) and tested using 2017 validation cohort (n=1,016,012). Multivariate logistic regression was used for the model. Main outcome: The primary outcome was postoperative 30-day C. difficile infection (CDI). Results: 0.39% of the patients (n=9,675) developed CDI and 42.3% (n=4,091) of CDI occurred post-discharge. The Clostridioides difficile risk prediction model had excellent AUC (area under the receiver operating characteristic curve) for postoperative C. difficile infection (training cohort=0.804, test cohort= 0.803). The model that includes hospital length of stay has a high AUC (training cohort=0.841, test cohort=0.838). Conclusion: The C. difficile prediction model provides a robust predictive tool for postoperative C. difficile infection.

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Multidisciplinary Approach to Clostridium difficile Infection in Adult Surgical Patients

Cited by 12 publications

References 20 publications

Long-Term Antibiotic Prophylaxis in Urology and High Incidence of Clostridioides difficile Infections in Surgical Adult Patients

Long-Term Antibiotic Prophylaxis in Urology and High Incidence of Clostridioides difficile Infections in Surgical Adult Patients

<p>Interprofessional Antimicrobial Stewardship Influencing <em>Clostridioides difficile</em> Infection: An 8-Year Study Using Antimicrobial Use Density</p>

Development and Validation of a web-based Postoperative Clostridioides difficile infection risk prediction model

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