scholarly journals Incidence of Clostridioides difficile infection at a Saudi Tertiary Academic Medical Center and compliance with IDSA/SHEA, ACG, and ESCMID guidelines for treatment over a 10-year period

2020 ◽  
Vol 13 (8) ◽  
pp. 1156-1160 ◽  
Author(s):  
Nouf A. Aljafel ◽  
Hadeel H. Al-Shaikhy ◽  
Maram A. Alnahdi ◽  
Abrar K. Thabit
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Clostridioides Difficile ◽  
Academic Medical ◽  
Clostridioides Difficile Infection

Test stewardship, frequency and fidelity: Impact on reported hospital-onset Clostridioides difficile

2019 ◽  
Vol 40 (6) ◽  
pp. 710-712 ◽  
Author(s):  
Michele S. Fleming ◽  
Olivia Hess ◽  
Heather L. Albert ◽  
Emily Styslinger ◽  
Michelle Doll ◽  
...  
Keyword(s):  
Decision Support ◽  
Medical Record ◽  
Critical Review ◽  
Medical Center ◽  
Academic Medical Center ◽  
Clostridioides Difficile ◽  
Testing Frequency ◽  
Academic Medical ◽  
Support Matrix ◽  
The Impact

AbstractWe assessed the impact of an embedded electronic medical record decision-support matrix (Cerner software system) for the reduction of hospital-onset Clostridioides difficile. A critical review of 3,124 patients highlighted excessive testing frequency in an academic medical center and demonstrated the impact of decision support following a testing fidelity algorithm.

scholarly journals Characteristics of patients infected with Clostridioides difficile at a Saudi Tertiary Academic Medical Center and assessment of antibiotic duration

Gut Pathogens ◽  
2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Khadijah M. Alammari ◽  
Abrar K. Thabit
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Acid Suppression ◽  
Prior Exposure ◽  
Clostridioides Difficile ◽  
Academic Medical ◽  
Days Of Therapy ◽  
Acid Suppression Therapy ◽  
Medical Wards ◽  
Hospital Acquired

Abstract Background Clostridioides difficile infection (CDI) is a common hospital-associated diarrhea. Several antibiotics commonly associate with CDI; however, limited data are available on the duration of exposure prior to CDI. Moreover, studies on the characteristics of CDI patients in Saudi Arabia are limited. Therefore, this study aimed to characterize CDI patients identified over 10 years and assess antibiotic days of therapy (DOT) prior to CDI. Methods This was a retrospective descriptive analysis of CDI patients at a Saudi tertiary academic medical center between December 2007 and January 2018. Patients characteristics, prior exposure to known CDI risk factors, and DOT of antibiotics prior to CDI incidence were assessed. Results A total of 159 patients were included. Median age was 62 years. Most cases were hospital-acquired (71.1%), non-severe (44.7%), and admitted to medical wards (81.1%). Prior exposure to antibiotics and acid suppression therapy were reported with the majority (76.1 and 75.5%, respectively). The most frequently prescribed antibiotics were piperacillin/tazobactam, ceftriaxone, meropenem, and ciprofloxacin with median DOTs prior to CDI incidence of 14 days for the β-lactams and 26 days for ciprofloxacin. The distribution of DOT was significantly different for piperacillin/tazobactam in different units (P = 0.003) where its median DOT was the shortest in medical wards (11 days), and for ciprofloxacin among different severity groups (P = 0.013), where its median DOT was the shortest in severe CDI patients (11 days). Conclusion Most patients in this study had hospital-acquired non-severe CDI and were largely exposed to antibiotics and acid suppression therapy. Therefore, such therapies should be revised for necessity.

scholarly journals Screening of Clostridioides difficile carriers in an urban academic medical center: Understanding implications of disease

2019 ◽  
pp. 1-5
Author(s):  
Sarah W. Baron ◽  
Belinda E. Ostrowsky ◽  
Priya Nori ◽  
David Y. Drory ◽  
Michael H. Levi ◽  
...  
Keyword(s):  
Proportional Hazards Model ◽  
Screening Program ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Significant Risk ◽  
Cox Proportional Hazards Model ◽  
Nursing Facility ◽  
Clostridioides Difficile ◽  
Academic Medical

Abstract Objective: Efforts to reduce Clostridioides difficile infection (CDI) have targeted transmission from patients with symptomatic C. difficile. However, many patients with the C. difficile organism are carriers without symptoms who may serve as reservoirs for spread of infection and may be at risk for progression to symptomatic C. difficile. To estimate the prevalence of C. difficile carriage and determine the risk and speed of progression to symptomatic C. difficile among carriers, we established a pilot screening program in a large urban hospital. Design: Prospective cohort study. Setting: An 800-bed, tertiary-care, academic medical center in the Bronx, New York. Participants: A sample of admitted adults without diarrhea, with oversampling of nursing facility patients. Methods: Perirectal swabs were tested by polymerase chain reaction for C. difficile within 24 hours of admission, and patients were followed for progression to symptomatic C. difficile. Development of symptomatic C. difficile was compared among C. difficile carriers and noncarriers using a Cox proportional hazards model. Results: Of the 220 subjects, 21 (9.6%) were C. difficile carriers, including 10.2% of the nursing facility residents and 7.7% of the community residents (P = .60). Among the 21 C. difficile carriers, 8 (38.1%) progressed to symptomatic C. difficile, but only 4 (2.0%) of the 199 noncarriers progressed to symptomatic C. difficile (hazard ratio, 23.9; 95% CI, 7.2–79.6; P < .0001). Conclusions: Asymptomatic carriage of C. difficile is prevalent among admitted patients and confers a significant risk of progression to symptomatic CDI. Screening for asymptomatic carriers may represent an opportunity to reduce CDI.

scholarly journals 54. The Effect of Targeting High-Risk Patients for Antimicrobial Stewardship Intervention on Hospital-Onset Clostridioides Difficile Infection Rates

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S146-S147
Author(s):  
Albert Yang ◽  
Monica Donnelley
Keyword(s):  
High Risk ◽  
Antimicrobial Stewardship ◽  
Negative Binomial ◽  
Prediction Interval ◽  
Medical Center ◽  
Academic Medical Center ◽  
Infection Rates ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
History Of

Abstract Background Clostridioides difficile infection contributes to significant burden on patients and the healthcare system, costing billions in excess costs every year for hospital care. Continued use of antibiotics after C. difficile infection diagnosis is a risk factor for recurrent infection. Also, individuals who have had a recurrence of C. difficile infection are at a higher risk of subsequent episodes. Methods This prospective, observational, pre-post study evaluated the effect of implementing a targeted antimicrobial stewardship initiative towards a high-risk target population on the rate of in-hospital C. difficile infection rates. High-risk targets were identified through an electronic health system report of admitted patients at a large academic medical center who were toxin assay positive or had a documented history of C. difficile infection. Subjects who met the criteria were assessed for interventions by the pharmacy-driven antimicrobial stewardship service. The primary outcome compared the hospital-onset C. difficile rates and standardized infection ratio (SIR) before and after implementation of the initiative. The SIR is reported to the National Healthcare Safety Network (NHSN) and is calculated as a ratio between the number of observed and predicted infections, which is adjusted for facility-specific factors that contribute C. difficile risk. Negative binomial regression was used to calculate the predicted C. difficile infections in the SIR. Poisson regression was used to generate a 95% prediction interval for the predicted C. difficile infection rate. Results The mean age of subjects was 63 years old and 85% had no history of prior C. difficile infection. The most common intervention was de-escalation of antibiotics (46%). The post-implementation SIR was 0.55 and hospital-onset C. difficile rate was 13, both of which were significantly lower than predicted. Conclusion Targeting patients who have a history of or are newly diagnosed with C. difficile infection may decrease hospital-onset C. difficile rates. Disclosures All Authors: No reported disclosures

scholarly journals Characteristics of Patients Infected With Clostridioides Difficile at a Saudi Tertiary Academic Medical Center and Assessment of Antibiotic Duration

2020 ◽  
Author(s):  
Khadijah M. Alammari ◽  
Abrar K. Thabit
Keyword(s):  
Medical Center ◽  
Descriptive Analysis ◽  
Academic Medical Center ◽  
Prior Exposure ◽  
Antibiotic Exposure ◽  
Clostridioides Difficile ◽  
Academic Medical ◽  
Days Of Therapy ◽  
Acid Suppression Therapy ◽  
Hospital Acquired

Abstract BackgroundClostridioides difficile infection (CDI) is a common hospital-associated diarrhea. Several antibiotics commonly associate with CDI; however, limited data are available on the duration of exposure prior to CDI development. Moreover, studies on the characteristics of CDI patients in Saudi Arabia are limited. Therefore, the objective of this study was to characterize CDI patients identified over 10 years and assess antibiotic days of therapy (DOT) prior to CDI.MethodsThis was a retrospective descriptive analysis of CDI patients identified via laboratory testing at a Saudi tertiary academic medical center between December 2007-January 2018. Patients characteristics, prior exposure to known CDI risk factors, and DOT of antibiotics prior to CDI incidence were assessed.ResultsA total of 162 patients were included. Median age was 61.5 years. Most cases were hospital-acquired (70.4%) and admitted to general medical wards (81.5%). Prior exposure to antibiotics and acid suppression therapy were reported with the majority (75.9 and 75.3%, respectively). The most frequently prescribed antibiotics were piperacillin/tazobactam, ceftriaxone, meropenem, and ciprofloxacin with median DOTs prior to CDI incidence of 16.5, 16, 16, and 28 days, respectively. The distribution of DOT was significantly different for piperacillin/tazobactam, ceftriaxone, and ciprofloxacin in different units (P < 0.05). Counterintuitively, patients in non-ICU wards had the shortest antibiotic exposure prior to CDI development.ConclusionAs CDI is a common hospital-acquired infection resulting mainly from antibiotic exposure, results from this study indicate the need to revise antibiotic therapy to assess necessity and discontinue it when deemed unnecessary within the first two weeks.

Universal screening for Clostridioides difficile at an urban academic medical center

2020 ◽  
pp. 1-2
Author(s):  
Maggie Collison ◽  
Cynthia Murillo ◽  
Rachel Marrs ◽  
Allison Bartlett ◽  
Vera Tesic ◽  
...  
Keyword(s):  
Universal Screening ◽  
Medical Center ◽  
Academic Medical Center ◽  
Screening Tests ◽  
Clostridioides Difficile ◽  
Academic Medical ◽  
Surgical Units

Abstract We implemented universal inpatient Clostridioides difficile screening at an 800-bed hospital. Over 3 years, 2,010 of 47,048 screening tests (4.2%) were positive, with significantly higher rates of C. difficile colonization on transplant units than medical-surgical units: 5.4% (152 of 2,801) versus 4.3% (880 of 20,564), respectively (P = .005). Compliance with screening ranged from 79% to 96%.

Gender differences in career progress and satisfaction in an academic medical center

2002 ◽  
Vol 2 (3) ◽  
pp. 95-104 ◽  
Author(s):  
JoAnn Manson ◽  
Beverly Rockhill ◽  
Margery Resnick ◽  
Eleanor Shore ◽  
Carol Nadelson ◽  
...  
Keyword(s):  
Gender Differences ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical ◽  
Career Progress
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