Use of Probiotics to Prevent Clostridium Difficile in the Skilled Nursing Facility Setting: Incorporating Evidence into SNF Practice Results in Very Low Incidence of Primary Clostridium Difficile Infection

2017 ◽  
Vol 18 (3) ◽  
pp. B19
Author(s):  
Lewis Greenstein ◽  
Lewis Greenstein ◽  
Sabine von Preyss-Friedman
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Skilled Nursing Facility ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Low Incidence

A Comprehensive Assessment Across the Healthcare Continuum: Risk of Hospital-Associated Clostridium difficile Infection Due to Outpatient and Inpatient Antibiotic Exposure

2015 ◽  
Vol 36 (12) ◽  
pp. 1409-1416 ◽  
Author(s):  
Sara Y. Tartof ◽  
Gunter K. Rieg ◽  
Rong Wei ◽  
Hung Fu Tseng ◽  
Steven J. Jacobsen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Southern California ◽  
Skilled Nursing Facility ◽  
Antibiotic Exposure ◽  
Kaiser Permanente ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Transfer Factors ◽  
Adjusted Risk

BACKGROUNDLimitations in sample size, overly inclusive antibiotic classes, lack of adjustment of key risk variables, and inadequate assessment of cases contribute to widely ranging estimates of risk factors for Clostridium difficile infection (CDI).OBJECTIVETo incorporate all key CDI risk factors in addition to 27 antibiotic classes into a single comprehensive model.DESIGNRetrospective cohort study.SETTINGKaiser Permanente Southern California.PATIENTSMembers of Kaiser Permanente Southern California at least 18 years old admitted to any of its 14 hospitals from January 1, 2011, through December 31, 2012.METHODSHospital-acquired CDI cases were identified by polymerase chain reaction assay. Exposure to major outpatient antibiotics (10 classes) and those administered during inpatient stays (27 classes) was assessed. Age, sex, self-identified race/ethnicity, Charlson Comorbidity Score, previous hospitalization, transfer from a skilled nursing facility, number of different antibiotic classes, statin use, and proton pump inhibitor use were also assessed. Poisson regression estimated adjusted risk of CDI.RESULTSA total of 401,234 patients with 2,638 cases of incident CDI (0.7%) were detected. The final model demonstrated highest CDI risk associated with increasing age, exposure to multiple antibiotic classes, and skilled nursing facility transfer. Factors conferring the most reduced CDI risk were inpatient exposure to tetracyclines and first-generation cephalosporins, and outpatient macrolides.CONCLUSIONSAlthough type and aggregate antibiotic exposure are important, the factors that increase the likelihood of environmental spore acquisition should not be underestimated. Operationally, our findings have implications for antibiotic stewardship efforts and can inform empirical and culture-driven treatment approaches.Infect. Control Hosp. Epidemiol. 2015;36(12):1409–1416

scholarly journals 1501. Risk Factors for Clostridium difficile Infection in Patients Hospitalized with Community-Acquired Pneumonia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S546-S546
Author(s):  
Abhishek Deshpande ◽  
Marya Zilberberg ◽  
Pei-Chun Yu ◽  
Peter Imrey ◽  
Michael Rothberg
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Laboratory Test ◽  
Clostridium Difficile Infection ◽  
Skilled Nursing Facility ◽  
Community Acquired Pneumonia ◽  
Small Sample ◽  
Skilled Nursing ◽  
Healthcare Facilities ◽  
Multiple Logistic Regression Modeling

Abstract Background Patients with community-acquired pneumonia (CAP) are often prescribed broad-spectrum antibiotics, putting them at risk for developing Clostridium difficile infection (CDI). Previous studies of risk factors for CDI in this population have suffered from small sample sizes. We examined the risk factors for CDI in patients hospitalized with CAP using a large US database. Methods We included adult patients admitted with CAP 2010–2015 to 175 US hospitals participating in Premier and providing administrative and microbiological data. Patients were identified as having CAP if they had a diagnosis of pneumonia, a chest radiograph, and were treated with antimicrobials on day 1 and for ≥3 days. Incident CDI was identified with ICD-9 diagnosis code (not present on admission) and a positive laboratory test. We used descriptive statistics and mixed multiple logistic regression modeling to mutually adjust and evaluate risk factors previously suggested in the CDI literature. Results Among 148,417 inpatients with pneumonia treated with antibiotics, 789 (0.53%) developed CDI. The median age was 75 years, and 53% were female. Compared with patients with no CDI, those with CDI were older (75 vs. 72 years), had more comorbidities (5 vs. 3), and were more likely to be admitted from SNF (15.7% vs. 7.3%) or hospitalized in the past 3 months (11.8% vs. 7.1) (all comparisons P < 0.001). After multivariable adjustment, factors significantly associated with development of CDI included increasing age, admission from a skilled nursing facility, and receipt of piperacillin/tazobactam, aztreonam or intravenous vancomycin (Figure 1). Receipt of third-generation cephalosporins or fluoroquinolones was not an independent predictor of CDI. Conclusion In a large US inpatient sample hospitalized for pneumonia and treated with antimicrobials, only 0.53% of the patients developed CDI as defined by an ICD-9 code and positive laboratory test. Reducing the exposure to healthcare facilities and certain high-risk antibiotics may reduce the burden of CDI in patients with CAP. Disclosures All authors: No reported disclosures.

Malpractice & Negligence: Cal. Supreme Court Clarifies Negligence Provisions under State’s Elder Abuse Act

1999 ◽  
Vol 27 (2) ◽  
pp. 203-203
Author(s):  
Kendra Carlson
Keyword(s):  
Health Care ◽  
Supreme Court ◽  
Health Care Providers ◽  
Elder Abuse ◽  
Skilled Nursing Facility ◽  
Pressure Sores ◽  
Care Providers ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
The Supreme Court

The Supreme Court of California held, in Delaney v. Baker, 82 Cal. Rptr. 2d 610 (1999), that the heightened remedies available under the Elder Abuse Act (Act), Cal. Welf. & Inst. Code, §§ 15657,15657.2 (West 1998), apply to health care providers who engage in reckless neglect of an elder adult. The court interpreted two sections of the Act: (1) section 15657, which provides for enhanced remedies for reckless neglect; and (2) section 15657.2, which limits recovery for actions based on “professional negligence.” The court held that reckless neglect is distinct from professional negligence and therefore the restrictions on remedies against health care providers for professional negligence are inapplicable.Kay Delaney sued Meadowood, a skilled nursing facility (SNF), after a resident, her mother, died. Evidence at trial indicated that Rose Wallien, the decedent, was left lying in her own urine and feces for extended periods of time and had stage I11 and IV pressure sores on her ankles, feet, and buttocks at the time of her death.

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