Increase in Use of Vancomycin for Clostridium difficile Infection in US Hospitals

2010 ◽  
Vol 31 (8) ◽  
pp. 867-868 ◽  
Author(s):  
Amy L. Pakyz ◽  
Norman V. Carroll ◽  
Spencer E. Harpe ◽  
Michael Oinonen ◽  
Ronald E. Polk
Keyword(s):  
Clostridium Difficile ◽  
Primary Treatment ◽  
Epidemic Strain ◽  
First Line ◽  
Oral Vancomycin ◽  
Treatment Practices ◽  
First Line Therapy ◽  
Life Threatening ◽  
Vancomycin Resistant ◽  
Serious Disease

Clostridium difficile infection (CDI) is a potentially serious disease for which the epidemiology has recently changed, because of an emerging drug-resistant strain of the pathogen. Metronidazole and oral vancomycin are the primary treatment agents.2 Metronidazole has been historically favored as the first-line agent, partly to reduce the selection pressure for vancomycin-resistant enterococci (VRE), although metronidazole can also select for VRE. Vancomycin was traditionally reserved for metronidazole treatment failure or life-threatening disease. In a study conducted before emergence of the epidemic strain, vancomycin was reported to be superior for the initial treatment of severe CDI and for treatment of CDI that does not respond to metronidazole. Expert opinion calling for the use of vancomycin as first-line therapy, especially for severe CDI emergence of the epidemic strain, and reports of decreased metronidazole efficacy may have impacted CDI treatment practices. The purpose of this study was to characterize trends in CDI treatment in US hospitals.

Clostridium difficile—Associated Diarrhea, an Emerging Epidemic: Therapeutic Options

2007 ◽  
Vol 20 (4) ◽  
pp. 347-353
Author(s):  
Christopher R. Emerson
Keyword(s):  
Clostridium Difficile ◽  
Hospital Admissions ◽  
Treatment Options ◽  
Infectious Diarrhea ◽  
First Line ◽  
Oral Vancomycin ◽  
Considerable Morbidity ◽  
Clostridium Difficile Associated Diarrhea ◽  
Pharmacologic Agents ◽  
Oral Metronidazole

Clostridum difficile—associated disease (CDAD) is the leading cause of infectious diarrhea and is associated with considerable morbidity and mortality. The incidence is estimated to range from 3.4 to 8.4 cases per 1000 hospital admissions, and it has become a growing problem at many institutions. Treatment options for CDAD are limited due to a paucity of new pharmacologic agents and studies examining other potential treatments. Historically oral metronidazole and oral vancomycin have been used as first-line agents in the treating CDAD, however recent reports of treatment failure and recurrence with these agents have surfaced. These reports illustrate a need for novel pharmacologic agents and a thorough review of currently available agents that may have activity against C difficile. Available data on the treatment of CDAD were extracted and reviewed to outline the appropriate management of CDAD.

scholarly journals Myth: Intravenous amiodarone is safe in patients with atrial fibrillation and Wolff–Parkinson–White syndrome in the emergency department

CJEM ◽  
2005 ◽  
Vol 7 (04) ◽  
pp. 262-265 ◽  
Author(s):  
Marius A. Tijunelis ◽  
Mel E. Herbert
Keyword(s):  
Atrial Fibrillation ◽  
Life Support ◽  
American Heart ◽  
Heart Association ◽  
Advanced Cardiac Life Support ◽  
First Line ◽  
First Line Therapy ◽  
Intravenous Amiodarone ◽  
Life Threatening ◽  
Wolff Parkinson White Syndrome

ABSTRACT Wolff–Parkinson–White (WPW) syndrome with atrial fibrillation (AF) is a potentially life-threatening problem requiring rapid conversion to sinus rhythm. The most recent American Heart Association guidelines for the treatment of patients with WPW, published in conjunction with the 2000 Advanced Cardiac Life Support (ACLS) guidelines, suggests that intravenous amiodarone is a first-line therapy for AF–WPW; however the evidence suggests this is a potentially dangerous myth.

scholarly journals A Tetraspecific VHH-Based Neutralizing Antibody Modifies Disease Outcome in Three Animal Models of Clostridium difficile Infection

2016 ◽  
Vol 23 (9) ◽  
pp. 774-784 ◽  
Author(s):  
Diane J. Schmidt ◽  
Gillian Beamer ◽  
Jacqueline M. Tremblay ◽  
Jennifer A. Steele ◽  
Hyeun Bum Kim ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Neutralizing Antibody ◽  
Antibiotic Resistant ◽  
Content Type ◽  
New Therapeutic Approaches ◽  
Cell Assays ◽  
Life Threatening ◽  
Hospital Stays ◽  
Serious Disease ◽  
Gnotobiotic Piglets

ABSTRACTClostridium difficileinfection (CDI), a leading cause of nosocomial infection, is a serious disease in North America, Europe, and Asia. CDI varies greatly from asymptomatic carriage to life-threatening diarrhea, toxic megacolon, and toxemia. The incidence of community-acquired infection has increased due to the emergence of hypervirulent antibiotic-resistant strains. These new strains contribute to the frequent occurrence of disease relapse, complicating treatment, increasing hospital stays, and increasing morbidity and mortality among patients. Therefore, it is critical to develop new therapeutic approaches that bypass the development of antimicrobial resistance and avoid disruption of gut microflora. Here, we describe the construction of a single heteromultimeric VHH-based neutralizing agent (VNA) that targets the two primary virulence factors ofClostridium difficile, toxins A (TcdA) and B (TcdB). Designated VNA2-Tcd, this agent has subnanomolar toxin neutralization potencies for bothC. difficiletoxins in cell assays. When given systemically by parenteral administration, VNA2-Tcd protected against CDI in gnotobiotic piglets and mice and to a lesser extent in hamsters. Protection from CDI was also observed in gnotobiotic piglets treated by gene therapy with an adenovirus that promoted the expression of VNA2-Tcd.

Squamous cell carcinoma of the anal canal: a review of the aetiology, presentation, staging, prognosis and methods available for treatment

Sexual Health ◽  
2012 ◽  
Vol 9 (6) ◽  
pp. 593 ◽  
Author(s):  
Ursula M. Szmulowicz ◽  
James S. Wu
Keyword(s):  
Human Papillomavirus ◽  
Anal Cancer ◽  
Squamous Cell ◽  
Primary Treatment ◽  
Causative Organism ◽  
First Line ◽  
First Line Therapy ◽  
Node Biopsy ◽  
Line Therapy ◽  
Exciting Potential

Anal cancer is an uncommon malignancy, with the majority of cases comprised of squamous cell carcinomas. The increasing incidence of this disease reflects a rise in the transmission of the human papillomavirus, the causative organism of most tumours. Abdominoperineal resection (APR), once the primary mode of treatment, has been supplanted by sphincter-saving combination chemoradiation as the first-line therapy. However, surgeons continue to play a role in the multidisciplinary management of patients with anal cancer for diagnosis and post-treatment surveillance. Sentinel node biopsy may identify patients with clinically and radiographically negative inguinal lymph nodes who will benefit from groin irradiation. In very select cases, the controversial means of local excision has been employed as primary treatment, often in conjunction with radiation and chemotherapy. The management of persistent or recurrent anal cancers following primary chemoradiation remains a concern, for which only salvage APR currently offers the possibility of a cure. The introduction of human papillomavirus vaccines presents the exciting potential for the eradication of the disease.

scholarly journals A rare case presentation of acute myo-pericarditis in a patient with lupus flare

2021 ◽  
Vol 11 (1) ◽  
pp. 21-22
Author(s):  
Luis Caraballo
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Rare Case ◽  
Inflammatory Disorder ◽  
Systemic Lupus ◽  
First Line ◽  
Case Presentation ◽  
First Line Therapy ◽  
Life Threatening ◽  
Autoimmune Etiology

Systemic lupus erythematosus (SLE) is a chronic, multisystem, inflammatory disorder of autoimmune etiology of unknown cause. Cardiac involvement during systemic lupus erythematosus (SLE) may include the pericardium, myocardium, valvular disease, including Libman-Sacks endocarditis, and coronary arteries. Myocarditis is a severe unusual feature most common in African-American that can be asymptomatic with a prevalence of 8-25% in patients with systemic lupus erythematosus. Acute myo-pericarditis with subsequent heart failure is a life threatening complication of SLE that needs to get recognized early to prevent mortality to the patient. Steroids is the first line therapy in patients with acute myopericarditis. Here we present a rare case of SLE flare presenting as Acute myopericarditis.

Corrigendum to: Squamous cell carcinoma of the anal canal: a review of the aetiology, presentation, staging, prognosis and methods available for treatment

Sexual Health ◽  
2018 ◽  
Vol 15 (5) ◽  
pp. 480
Author(s):  
Ursula M. Szmulowicz ◽  
James S. Wu
Keyword(s):  
Human Papillomavirus ◽  
Anal Cancer ◽  
Squamous Cell ◽  
Primary Treatment ◽  
Causative Organism ◽  
First Line ◽  
First Line Therapy ◽  
Node Biopsy ◽  
Line Therapy ◽  
Exciting Potential

Anal cancer is an uncommon malignancy, with the majority of cases comprised of squamous cell carcinomas. The increasing incidence of this disease reflects a rise in the transmission of the human papillomavirus, the causative organism of most tumours. Abdominoperineal resection (APR), once the primary mode of treatment, has been supplanted by sphincter-saving combination chemoradiation as the first-line therapy. However, surgeons continue to play a role in the multidisciplinary management of patients with anal cancer for diagnosis and post-treatment surveillance. Sentinel node biopsy may identify patients with clinically and radiographically negative inguinal lymph nodes who will benefit from groin irradiation. In very select cases, the controversial means of local excision has been employed as primary treatment, often in conjunction with radiation and chemotherapy. The management of persistent or recurrent anal cancers following primary chemoradiation remains a concern, for which only salvage APR currently offers the possibility of a cure. The introduction of human papillomavirus vaccines presents the exciting potential for the eradication of the disease.

scholarly journals Pharmacokinetics of Dantrolene in the CVVH/PE Treatment of Malignant Hyperthermia in a 14-year-old Chinese Boy: A Case Report and Literature Review

2021 ◽  
Author(s):  
Xiao-Xiao LI ◽  
Chao Li ◽  
Yang Zhou ◽  
Xin Xiong ◽  
Chuhui Wang ◽  
...  
Keyword(s):  
Malignant Hyperthermia ◽  
Compartment Model ◽  
Volume Of Distribution ◽  
First Line ◽  
Old Chinese ◽  
Cervical Spine Surgery ◽  
First Order ◽  
First Line Therapy ◽  
Line Therapy ◽  
Life Threatening

Malignant hyperthermia (MH) is a rare life-threatening response that triggered by exposure to specific anesthetics commonly used during surgery interventions. Dantrolene is a well-known drug which used as first-line therapy for MH. A 14-year-old Chinese boy with a mutation in RYR1 whose muscle biopsy diagnosis was central core disease (CCD) occurred MH after cervical spine surgery underwent general anesthesia without volatile anesthetics or succinylcholine. The MH crisis treatment workflow was started and intravenous dantrolene was used soon which combined with sequent continuous veno-venous hemofiltration (CVVH) and plasma exchange (PE) therapy. We explored the pharmacokinetics of dantrolene during the treatment and the results showed that a one-compartment model with first-order absorption and elimination was sufficient to characterize dantrolene pharmacokinetics. The clearance estimate for dantrolene was 0.43 mL/(min*kg) and volume of distribution was 0.61 L/kg. The clearance of dantrolene was significantly affected by CVVH and PE.

scholarly journals Mucormycosis: the black fungus maiming COVID-19 patients in India

2021 ◽  
Vol 9 (8) ◽  
pp. 2535
Author(s):  
Priyanka Ghogre
Keyword(s):  
Developed Countries ◽  
The Novel ◽  
First Line ◽  
Airborne Spores ◽  
First Line Therapy ◽  
Disease Patterns ◽  
Line Therapy ◽  
Wide Range ◽  
Life Threatening ◽  
Lipid Formulations

The COVID-19 infection caused by the novel SARS-CoV-2 may be associated with a wide range of disease patterns, ranging from mild to life-threatening pneumonia. Mucormycosis is an emerging angioinvasive fungal infection caused by the ubiquitous filamentous fungi of the Mucorales order of the class of Zygomycetes. The prevalence of mucormycosis in India is about 80 times the prevalence in developed countries. Mucorales invade deep tissues via inhalation of airborne spores, percutaneous inoculation or ingestion. Rhino-orbito-cerebral form of mucormycosis is a relatively fatal infection and mortality rate rises to 50-85%. Extensive use of corticosteroids/monoclonal antibodies/broad-spectrum antibiotics may lead to the development/exacerbation of a preexisting fungal disease. Only amphotericin B and its lipid formulations and recently isavuconazole have been studied as first-line therapy for mucormycosis. On the contrary, posaconazole has been mainly studied as salvage therapy.

Oral vancomycin prophylaxis for the prevention of Clostridium difficile infection: A systematic review and meta-analysis

2020 ◽  
Vol 41 (11) ◽  
pp. 1302-1309
Author(s):  
Sumbal Babar ◽  
Bara El Kurdi ◽  
Mahmoud El Iskandarani ◽  
Ibrahim Haddad ◽  
Zaid Imam ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clostridium Difficile ◽  
Meta Analysis ◽  
Total Daily Dose ◽  
Oral Vancomycin ◽  
Daily Dose ◽  
Risk Patients ◽  
At Risk Populations ◽  
Vancomycin Resistant ◽  
Egger Test

AbstractObjective:Recently, oral vancomycin prophylaxis (OVP) has been suggested for the prevention of Clostridium difficile infection (CDI). We conducted a systematic review and meta-analysis to investigate the efficacy and safety of this approach.Design:Systematic review and meta-analysis.Methods:We conducted a computerized search of MEDLINE, EMBASE, and Cochrane databases from inception to March 2019 for publications investigating OVP for CDI prevention. Results were screened for eligibility. Relevant data were extracted and analyzed. Publication bias was assessed using the Egger test.Results:Ultimately, 8 retrospective studies and 1 prospective study examining 2174 patients, published between 2016 and 2019 were included in the review. OVP was associated with decreased CDI (odds ratio, 0.263; 95% confidence interval, 0.13–0.52) with considerable heterogeneity (I2 = 61%). Meta-regression showed that total daily dose of OVP correlated with CDI, explaining 100% of heterogeneity between studies. Furthermore, 3 studies evaluated the risk of vancomycin-resistant enterococci (VRE) infection after OVP and found no significant increase.Conclusion:Our results suggest that OVP might decrease CDI rates in at-risk populations, although this conclusion should be interpreted with caution. Higher daily doses of OVP might increase CDI. Although the use of OVP in high-risk patients may reduce CDI, this suggestion has yet to be validated by prospective blinded randomized controlled trials.

Lack of Increased Colonization with Vancomycin-Resistant Enterococci during Preferential Use of Vancomycin for Treatment during an Outbreak of Healthcare-Associated Clostridium difficile Infection

2010 ◽  
Vol 31 (7) ◽  
pp. 710-715 ◽  
Author(s):  
Mark Miller ◽  
Lisa Bernard ◽  
Melissa Thompson ◽  
Daniel Grima ◽  
Jocelyne Pepin
Keyword(s):  
Clostridium Difficile ◽  
Oral Vancomycin ◽  
Outbreak Period ◽  
Vancomycin Resistant Enterococci ◽  
Period 2 ◽  
Jewish General Hospital ◽  
Vancomycin Resistant ◽  
Healthcare Associated ◽  
Vancomycin Treatment ◽  
Oral Metronidazole

Objective.To assess whether use of oral vancomycin for treatment during an outbreak of Clostridium difficile infection (CDI) was associated with increased rates of colonization with vancomycin-resistant enterococci (VRE)..Design.A retrospective analysis of hospital databases.Setting.The Jewish General Hospital in Montreal, Quebec, Canada.Methods.We collected data regarding VRE colonization and CDI from November 1, 2000, through September 30, 2007, during which policies of preferential oral metronidazole or vancomycin treatment were implemented to control an outbreak of CDI. Four periods were considered: period 1, the preoutbreak period when metronidazole was used; period 2, the CDI outbreak period when metronidazole was used; period 3, the postoutbreak period when vancomycin was used; and period 4, the postoutbreak period when metronidazole was used.Results.A total of 2,412 cases of CDI and 425 cases of VRE colonization were identified. The rate of CDI increased significantly during period 2 and decreased to preoutbreak levels during period 3. The rate of VRE also increased during period 2 and decreased during the first 18 months of period 3. A clonal outbreak of cases of VRE (VanA) colonization was observed toward the end of period 3 and into period 4. Excluding the period of the clonal outbreak, there was a strong correlation between the number of cases of CDI and VRE colonization (r = 0.736; P = .001) and a negative association between VRE colonization and vancomycin use (r = —0.765; P = .04).Conclusions.Increased vancomycin use was not associated with an increase in VRE colonization over a 2-year period. Restriction of vancomycin use during CDI outbreaks because of the fear of increasing VRE colonization may not be warranted.

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