Oral vancomycin prophylaxis against recurrent Clostridioides difficile infection: Efficacy and side effects in two hospitals

2020 ◽  
Vol 41 (8) ◽  
pp. 908-913
Author(s):  
Ioannis M. Zacharioudakis ◽  
Fainareti N. Zervou ◽  
Yanina Dubrovskaya ◽  
Michael S. Phillips
Keyword(s):  
New York ◽  
Absolute Number ◽  
Oral Vancomycin ◽  
Clostridioides Difficile ◽  
Before And After ◽  
Clostridioides Difficile Infection ◽  
History Of ◽  
High Benefit ◽  
To Receive ◽  
Selection Of

AbstractObjective:The data regarding the effectiveness of chemical prophylaxis against recurrent C. difficile infection (CDI) remain conflicting.Design:Retrospective cohort study on the effectiveness of oral vancomycin for prevention of recurrent CDI.Setting:Two academic centers in New York.Methods:Two participating hospitals implemented an automated alert recommending oral vancomycin 125 mg twice daily in patients with CDI history scheduled to receive systemic antimicrobials. Measured outcomes included breakthrough and recurrent CDI rates, defined as CDI during and 1 month after initiation of prophylaxis, respectively. A self-controlled, before-and-after study design was employed to examine the effect of vancomycin prophylaxis on the prevalence of vancomycin-resistant Enterococcus spp (VRE) colonization and infection.Results:We included 264 patients in the analysis. Breakthrough CDI was identified in 17 patients (6.4%; 95% confidence interval [CI], 3.8%–10.1%) and recurrent in 22 patients (8.3%; 95% CI, 5.3%–12.3%). Among the 102 patients with a history of CDI within the 3 months preceding prophylaxis, 4 patients (3.9%; 95% CIs, 1.1%–9.7%) had breakthrough CDI and 9 had recurrent disease (8.8%; 95% CIs, 4.1%–16.1%). In the 3-month period following vancomycin prophylaxis, we detected a statistically significant increase in both the absolute number of VRE (χ2, 0.003) and the ratio of VRE to VSE isolates (χ2, 0.003) compared to the combined period of 1.5 months preceding and the 3–4.5 months following prophylaxis. This effect persisted 6 months following prophylaxis.Conclusions:Prophylactic vancomycin is an effective strategy to prevent CDI recurrence, but it increases the risk of VRE colonization. Thus, a careful selection of patients with high benefit-to-risk ratio is needed for the implementation of this preventive policy.

scholarly journals 2412. Oral Vancomycin Prophylaxis Against Recurrent Clostridioides difficile Infection: Efficacy and Side-effects: Two Hospitals Experience

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S833-S833
Author(s):  
Ioannis Zacharioudakis ◽  
Fainareti Zervou ◽  
Yanina Dubrovskaya ◽  
Michael Phillips
Keyword(s):  
New York ◽  
Extended Period ◽  
Final Analysis ◽  
Absolute Number ◽  
Infection Prevalence ◽  
Enterococcus Species ◽  
Oral Vancomycin ◽  
Clostridioides Difficile ◽  
History Of ◽  
The Absolute

Abstract Background Clostridioides difficile is the most common hospital-acquired pathogen with an unchanged infection prevalence between 2011–2015. The data regarding the effectiveness of chemical prophylaxis to prevent recurrent C. difficile infection (CDI) are conflicting. Methods We conducted a retrospective study of hospitalized patients with CDI history in 2 New York academic hospitals over a 4.5-year period to determine the effectiveness of vancomycin prophylaxis for CDI prevention. The participating hospitals implemented an automated alert to providers recommending oral vancomycin 125 mg twice daily in patients with a history of CDI scheduled to receive any systemic antimicrobials for the duration of therapy and 5 days thereafter. Measured outcomes included the rate of breakthrough and recurrent CDI, defined as CDI during and in the one-month following prophylaxis, respectively. A self-controlled, before and after study design was employed to examine whether the use of oral vancomycin was associated with an increase in the prevalence of vancomycin-resistant Enterococcus species (VRE) both in absolute numbers and in comparison to vancomycin-sensitive Enterococcus species (VSE) in the period following vancomycin prophylaxis. Results 264 patients were included in the final analysis. Breakthrough CDI was identified in 17 (6.4%; 95% CIs 3.8%–10.1%) and recurrent CDI in 22 (8.3%; 95% CIs 5.3%–12.3%) patients. Of the 102 patients with a history of CDI within the 3 months preceding the administration of prophylaxis 4 (3.9%, 95% CIs 1.1%-9.7%) had breakthrough CDI and 9 had recurrent disease (8.3%, 95% CIs 5.3%–12.3%). In the 3 months following vancomycin prophylaxis there was an increase in both the absolute number of VRE and the ratio of VRE to VSE isolates compared with the combined period of 1.5 months preceding and the 3–4.5 months following the administration of prophylaxis. The increase in the absolute number of VRE colonized patients remained in the extended period of 6 months following prophylaxis. Conclusion Prophylactic vancomycin is an effective strategy to prevent CDI recurrence, but is associated with an increase in VRE colonization in the immediate period after administration. The risk of VRE infection should lead to careful selection of patients at the highest risk for CDI recurrence. Disclosures All authors: No reported disclosures.

scholarly journals 1376. Oral Vancomycin as Secondary Prophylaxis Against Clostridioides difficile Infection in Pediatric Patients

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S698-S698
Author(s):  
Hongkai Bao ◽  
Yanina Dubrovskaya ◽  
John Papadopoulos ◽  
Justin Siegfried ◽  
Cristian Merchan ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Odds Ratio ◽  
Protective Factor ◽  
Pediatric Patients ◽  
Antibiotic Exposure ◽  
Oral Vancomycin ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
History Of ◽  
Systemic Antibiotics

Abstract Background Secondary oral vancomycin prophylaxis (OVP) has been utilized in adults with a history of Clostridioides difficile infection (CDI) while receiving systemic antibiotics to prevent CDI recurrence. However, this practice is poorly described in pediatric patients. Rates of CDI recurrence in pediatric patients range from 10-40% and is associated with morbidity and mortality. This study assessed the efficacy and safety of secondary OVP in pediatric patients with subsequent antibiotic exposure. Methods This retrospective study evaluated pediatric patients ≤18 years with any history of clinical CDI and receiving systemic antibiotics in a subsequent encounter during the time period of 2013-2019. Patients who received OVP 10 mg/kg (up to 125 mg per dose) every 12 hours during concomitant antibiotics were compared to those who did not. The primary outcome was CDI recurrence within 8 weeks following antibiotic exposure. Secondary outcomes included time to recurrence, severity of recurrence, and isolation of vancomycin-resistant enterococci (VRE) from any site. Risk factors for CDI recurrence were assessed using logistic regression. Results A total of 153 patients were screened for inclusion, of which 32 and 47 patients were assigned to the OVP and no OVP group, respectively. Median age was 8.6 years and the most common comorbidities were malignancy (47%) and immunosuppression (46%). Median time since last CDI to study inclusion was 64.5 days in the OVP group and 90 days in the no OVP group, P=0.320. Compared to the no OVP group, OVP patients had longer hospital stays (5 vs 14 days, P=0.001) and more concomitant antibiotic exposure (8 vs 12.5 days, P=0.001). Median duration of OVP was 12 days. CDI recurrence occurred in 12 patients and was significantly lower in the OVP vs no OVP group (3.1% vs 23.4%; odds ratio, 0.106; 95% confidence interval, 0.013-0.864; P=0.022). VRE was not isolated in any patients. After adjustment in a multivariate analysis, only secondary OVP remained as a protective factor against recurrence (odds ratio, 0.082; 95% confidence interval, 0.009-0.748; P=0.027). Conclusion Secondary OVP effectively reduces the risk of recurrent CDI in pediatric patients with a history of CDI while receiving systemic antibiotics. Future prospective studies should validate these findings. Disclosures Cristian Merchan, PharMD, BCCCP, abbive (Speaker’s Bureau)

scholarly journals 785. Association between Prevalence of Laboratory-Identified Clostridioides difficile Infections (CDIs) and CDI Antibiotic Treatment in U.S. Acute Care Hospitals, 2018

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S437-S437
Author(s):  
Kerui Xu ◽  
Andrea L Benin ◽  
Hsiu Wu ◽  
Jonathan R Edwards ◽  
Qunna Li ◽  
...  
Keyword(s):  
Acute Care ◽  
Acute Care Hospitals ◽  
Antibiotic Use ◽  
Prevalence Rates ◽  
Hospital Level ◽  
First Line ◽  
Oral Vancomycin ◽  
Patient Admissions ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection

Abstract Background Clostridioides difficile infections (CDIs) are an urgent public health threat, accounting for 223,900 infections and 12,800 deaths in hospitalized patients annually. In early 2018, the Infectious Disease Society of America (IDSA) recommended oral vancomycin or fidaxomicin as the first-line antibiotics for CDIs. To track the uptake of IDSA’s recommendations, we evaluated the association between CDI prevalence and use of first-line antibiotics in hospitals reporting to the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN). Methods We matched 2018 hospital-level, NHSN data on laboratory-identified CDIs with NHSN antimicrobial use (AU) data for the same time period. Hospitals that submitted < 6 months of either data type in 2018 were excluded. The association between quarterly hospital-level CDI prevalence rates per 100 patient-admissions and use of CDI antibiotics (oral vancomycin plus fidaxomicin) per 1,000 days-present was evaluated using Pearson’s linear correlation coefficient and using Goodman and Kruskal’s gamma (G) on ordinal quartiles to assess rates of discordant pairs. Results Among the 2735 hospital-level quarters based on 714 hospitals included in the study, CDI prevalence (median: 0.46 per 100 patient-admissions) and CDI antibiotic use (median: 8.85 antibiotic-days per 1,000 days-present) demonstrated only a moderately positive correlation (r = 0.48). Among hospitals in the highest quartile for CDI prevalence, 5.1% were in the lowest quartile for antibiotic use. Among hospitals in the highest quartile for antibiotic use, 5.3% were in the lowest quartile for CDI prevalence, and 54.2% were in the highest quartile for CDI prevalence (G = 0.60; 95% CI: 0.57–0.63). Correlation of hospital-level Clostridioides difficile infection (CDI) prevalence rates and oral vancomycin and fidaxomicin use in U.S. acute care hospitals, 2018 Distribution of hospital-level Clostridioides difficile infection (CDI) prevalence rates and oral vancomycin and fidaxomicin use in ordinal quartiles (Q1–Q4) to access rates of discordant pairs Conclusion The moderate correlation and discordant rates suggest that vancomycin and fidaxomicin are less frequently used as primary antibiotics in some hospitals; whereas in others, CDI antibiotic use is occurring in the absence of positive laboratory tests for CDI. To further investigate this discordance, there is a need to assess hospitals’ prescribing and testing practices in an ongoing manner. These findings may be useful to serve as baseline for measuring progress of appropriateness of treatment and testing for CDIs. Disclosures All Authors: No reported disclosures

scholarly journals 2373. Impact of a Change in Testing Strategy for Clostridioides difficile Infection on a Publicly Reported Metric and Treatment Days of Therapy

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S818-S819
Author(s):  
Ryan Miller ◽  
Jose A Morillas ◽  
Joanne Sitaras ◽  
Jacob Bako ◽  
Elizabeth A Neuner ◽  
...  
Keyword(s):  
Health System ◽  
Diagnostic Testing ◽  
Cleveland Clinic ◽  
Public Reporting ◽  
Testing Strategy ◽  
Clostridioides Difficile ◽  
Days Of Therapy ◽  
Before And After ◽  
Clostridioides Difficile Infection ◽  
The Impact

Abstract Background In an effort to optimize diagnostic testing for Clostridioides difficile infection (CDI) our health system changed from stand-alone PCR testing to a “2-step” approach wherein all positive PCR results reflexed to an EIA. We report the effects of this change on publicly reported CDI metrics and treatment days of therapy (DOT). Methods The setting includes 10 Cleveland Clinic Health System hospitals in northeast Ohio and one in Florida. On June 12, 2018, 9 NE Ohio hospitals changed from PCR alone to PCR followed by EIA. Stand-alone PCR testing remained at one and GDH / EIA / PCR for discordant for another. Testing volumes were obtained from the microbiology laboratory. C. difficile LabID event SIRs were obtained from NHSN. Public reporting interpretative categories were identified based on SIR for second half of 2018. DOT for CDI agents were obtained from an antimicrobial stewardship database. Results Among hospitals that changed strategy the volume of PCR testing and the percent PCR + was similar between time periods. EIA positivity ranged from 23% to 53%. 4/11 hospitals improved their public reporting category: 3/9 that changed testing strategy and 1/2 that did not (Table 1). Two of 3 that changed strategy and improved public reporting also had a decrease in DOT. DOT increased in the 2 hospitals that did not change strategy. Conclusion Six months after adopting a 2-step CDI testing strategy 7 of 9 hospitals had a lower SIR with 3 also demonstrating an improvement in public reporting category favorably impacting reputational and reimbursement risk for our healthcare system. CDI agent DOT was similar before and after the change. The impact of choice of test on publicly reported metrics demonstrates the difficulty of utilizing a proxy for hospital onset CDI, the CDI LabID event, as a measure of quality of care provided. Disclosures All authors: No reported disclosures.

Konstantin Stanislavsky Michael Chekhov Vsevolod Meyerhold Jacques Lecoq

2006 ◽  
Vol 47 (1) ◽  
pp. 146-150
Author(s):  
Jerri Daboo
Keyword(s):  
New York ◽  
Twentieth Century ◽  
Historical Context ◽  
Actor Training ◽  
Konstantin Stanislavsky ◽  
Four Books ◽  
History Of ◽  
Complete Series ◽  
Performer Training ◽  
Selection Of

The Routledge Performance Practitioners series, edited by Franc Chamberlain, is a new set of introductory guides to a range of key figures in the development of twentieth-century performance practice. Each book focuses on a single practitioner, examining his or her life, historical context, key writings, and productions, and a selection of practical exercises. These concise volumes are intended to offer students an initial introduction to the practitioner and to “provide an inspiring spring-board for future study, unpacking and explaining what can initially seem daunting” (Merlin, ii). The list of practitioners in the complete series include Stanislavsky, Brecht, Boal, Lecoq, Grotowski, Anna Halprin, and Ariane Mnouchkine, thus examining a range of performance styles and practices, creating a valuable overview of the development of performer training through the twentieth and into the twenty-first centuries. Such interest in the history of specific approaches to training performers has been addressed in other volumes, such as Twentieth-Century Actor Training, edited by Alison Hodge (New York: Routledge, 2000), and Acting (Re)considered: A Theoretical and Practical Guide, edited by Phillip Zarrilli (London: Routledge 2002). Both those collections contain in-depth chapters focusing on aspects of the selected practitioners' theoretical and practical approaches to the principles and concerns in their work. Where the books in the Routledge Performance Practitioners series differ is that they offer a more general overview of the practitioner in one volume, and in addition to the historical context, they provide a set of practical exercises that can be carried out by the student or teacher, as well as by the actor or director. The books are well presented, divided into clear sections, with relevant photographs and diagrams. There are also sidebars providing definitions and further information on key figures and terms mentioned in the main text. This review covers the first four books in the series, examining the work of Konstantin Stanislavsky, Michael Chekhov, Vsevolod Meyerhold, and Jacques Lecoq.

Surviving the City: The Chinese Immigrant Experience in New York City, 1890–1970. By Xinyang Wang. [Lanham, MD: Rowman and Littlefield, 2001. 157 pp. $17.95. ISBN 0-7425-0891-9.]

2003 ◽  
Vol 173 ◽  
pp. 214-251
Author(s):  
Bernard P. Wong
Keyword(s):  
New York ◽  
New York City ◽  
York City ◽  
Chinese Immigrant ◽  
Group Solidarity ◽  
Labour Movement ◽  
Economic Forces ◽  
History Of ◽  
The City ◽  
Selection Of

The author, Xinyang Wang, is a social historian who reassesses the history of early Chinese immigrants in New York City, departing from the ethnic-heritage and racism analyses of immigrants' adaptation to America. Instead, he pursues an actor-oriented approach, showing how economic forces played an important part in the decision-making activities of the immigrants, such as the selection of neighbourhoods for settlement, participation in the labour movement, return to China, and intensification of intra-group solidarity.

scholarly journals The space between photography and film : an object study from the Warner Bros.-First National Keybook collection

2021 ◽  
Author(s):  
Frances Cullen
Keyword(s):  
New York ◽  
Academic Disciplines ◽  
History Of Photography ◽  
Cinema Studies ◽  
42Nd Street ◽  
History Of ◽  
Aesthetic Characteristics ◽  
Selection Of

Historically and conceptually, film stills occupy a precarious position between two academic disciplines: cinema studies and the history of photography. They are overshadowed in collections by more prominent and "valuable" cinematic or photographic objects competing for the same space and money; and they have received relatively little attention in scholarship, exhibitions and publications. The film still is a unique and distinctive genre of object, possessing its own history, physicality, and aesthetic. After establishing a historical and descriptive context for understanding the film still as an object with multiple incarnations - commercial, nostalgic, historical, educational, artistic - this thesis transitions into an analysis of actual stills. By examining the physical and aesthetic characteristics of a small selection of stills from George Eastman House's "Warner Bros.-First National Keybook Collection," drawn from the keybooks of Other Women's Husbands (1926), Lights of New York, and 42nd Street, an argument emerges for the establishment of the film still as a genre of photographic object distinguishable by its physical and aesthetic characteristics as much as by its origin.

scholarly journals Brief Training in Mindfulness Meditation Reduces Symptoms in Patients with a Chronic or Recurrent Lifetime History of Depression: A Randomized Controlled Study

2017 ◽  
Author(s):  
Emilia Winnebeck ◽  
Maria Fissler ◽  
Matti Gärtner ◽  
Paul Chadwick ◽  
Thorsten Barnhofer
Keyword(s):  
Mindfulness Meditation ◽  
Controlled Study ◽  
Stress Buffering ◽  
Beneficial Effects ◽  
Lifetime History ◽  
Brief Training ◽  
Treatment Of Depression ◽  
Before And After ◽  
History Of ◽  
To Receive

Background: Training in mindfulness has been introduced to the treatment of depression as a means of relapse prevention. However, from a stress-buffering perspective, mindfulness techniques would be expected to unfold their beneficial effects particularly in those who are currently suffering from symptoms. This study investigated whether a brief and targeted mindfulness-based intervention can reduce symptoms in acutely depressed patients.Methods: Seventy-four patients with a chronic or recurrent lifetime history were randomly allocated to receive either a brief mindfulness-based intervention (MBI) encompassing three individual sessions and regular home practice or a control condition that combined psycho-educational components and regular rest periods using the same format as the MBI. Self-reported severity of symptoms, mindfulness in every day life, ruminative tendencies and cognitive reactivity were assessed before and after intervention.Results: Patients in the MBI condition showed pronounced and significantly stronger reductions in symptoms than those in the control condition. In the MBI group only, patients showed significant increases in mindfulness, and significant reductions in ruminative tendencies and cognitive reactivity.Conclusions: Findings are in line with a stress-buffering account of mindfulness and suggest that brief targeted mindfulness interventions can help to reduce symptoms in acutely depressed patients with chronic or recurrent lifetime history.

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