scholarly journals Impact of guidelines and enhanced antibiotic stewardship on reducing broad-spectrum antibiotic usage and its effect on incidence of Clostridium difficile infection

2011 ◽  
Vol 66 (9) ◽  
pp. 2168-2174 ◽  
Author(s):  
Moïra Joëlle Talpaert ◽  
Guduru Gopal Rao ◽  
Ben Symons Cooper ◽  
Paul Wade
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Broad Spectrum ◽  
Antibiotic Stewardship ◽  
Antibiotic Usage ◽  
Broad Spectrum Antibiotic

scholarly journals 2422. Effectiveness of a Probiotic for Primary Prevention of Clostridium difficile Infection and Antibiotic-Associated Diarrhea among Hospitalized Patients Receiving Broad-Spectrum Antibiotics

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S836-S837
Author(s):  
Khanh-Linh Le ◽  
Heather Young ◽  
Timothy C Jenkins ◽  
Robert Tapia ◽  
Katherine C Shihadeh
Keyword(s):  
Primary Prevention ◽  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Broad Spectrum ◽  
Hospitalized Patients ◽  
Broad Spectrum Antibiotic ◽  
Probiotic Group ◽  
Broad Spectrum Antibiotics ◽  
Days Of Therapy ◽  
Antibiotic Associated Diarrhea

Abstract Background Prior to 2016, Denver Health Medical Center had a higher-than-expected rate of hospital onset Clostridium difficile infection (HO-CDI). A multifaceted CDI prevention plan was implemented, including the use of a probiotic as primary prevention for HO-CDI and antibiotic-associated diarrhea (AAD) in inpatients receiving broad-spectrum antibiotics. We aimed to study the effectiveness of probiotic use in this clinical context. Methods During the intervention, inpatient orders for a broad-spectrum antibiotic triggered a best practice advisory recommending once daily co-administration of 100 billion units of a probiotic containing Lactobacillus casei, L. rhamnosus, and L. acidophilus (BioK+ ®). To evaluate effectiveness and safety of this intervention, we performed a retrospective cohort study including adult inpatients who received > 24 hours of a broad-spectrum antibiotic between April 2016 and March 2018. The primary endpoint was the incidence of HO-CDI (> 3 days after admission) compared between patients who received antibiotics alone vs. antibiotics plus the probiotic. Secondary endpoints were the incidence of AAD, defined as a negative CDI test after antibiotic initiation, and the incidence of Lactobacillus species identified in clinical cultures. Results 3,291 patients were included; 1,835 received antibiotics alone and 1,456 received antibiotics plus the probiotic. Baseline characteristics between groups were similar, except patients in the antibiotic alone group had a greater incidence of cirrhosis and proton-pump inhibitor use (16.1% vs 10.1%, P < 0.001; 39.1% vs 31.5%, P < 0.001). Length of stay and antibiotic days of therapy were longer in the antibiotic plus probiotic group [6 days (IQR, 3–11) vs 6 days (IQR, 4–12), P = 0.014; 4 days (IQR, 3–7) vs 5 days (IQR, 3–7), P < 0.001]. The incidence of HO-CDI (37, 2% vs 35, 2.4%; P = 0.450) and AAD (231, 12.6% vs 199, 13.7%; P = 0.362) were similar between groups. Lactobacillus was identified in at least one clinical culture from 0.2% (3/1835) and 0.3% (4/1456) of patients in the antibiotic alone group and antibiotic plus probiotic group, respectively (P = 0.497). Conclusion In hospitalized patients receiving broad-spectrum antibiotics, co-administration of a probiotic did not appear to reduce the incidence of HO-CDI or AAD. Disclosures All authors: No reported disclosures.

Pediatric antibiotic stewardship: successful interventions to reduce broad-spectrum antibiotic use on general pediatric wards

Infection ◽  
2017 ◽  
Vol 45 (4) ◽  
pp. 493-504 ◽  
Author(s):  
Katharina Kreitmeyr ◽  
Ulrich von Both ◽  
Alenka Pecar ◽  
Johannes P. Borde ◽  
Rafael Mikolajczyk ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Antibiotic Stewardship ◽  
Antibiotic Use ◽  
Broad Spectrum Antibiotic

scholarly journals 2420. Reduced hospital-onset Clostridium difficile infection incidence following Saccharomyces boulardii co-administration with broad-spectrum antibiotics during hospitalization.

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S835-S836
Author(s):  
Eric Wombwell ◽  
Mark E Patterson ◽  
Bridget Bransteitter ◽  
Lisa Gillen
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Broad Spectrum ◽  
Hospital Admissions ◽  
Group Analysis ◽  
Probiotic Strain ◽  
Saccharomyces Boulardii ◽  
Protective Effects ◽  
Convenience Sample ◽  
Broad Spectrum Antibiotics

Abstract Background Conflicting evidence in smaller randomized trials and meta-analyses regarding the protective effects of probiotics against Clostridium difficile infection underscore the need for further study. Our objective was to evaluate the effect of a single probiotic strain, Saccharomyces boulardii, at a standardized dose on hospital-onset C. difficile (HO-CDI) rates within hospitalizations administered broad-spectrum antibiotics. Methods Retrospective cohort study merging hospital prescribing data with C. difficile case data from the National Health Safety Network at a 220-bed level-2 trauma center nonacademic hospital. A convenience sample of 8,763 hospital admissions administrated at least one dose of a fluoroquinolone, clindamycin, or β-lactam class antibiotic during hospitalization was assessed. Hospitalizations were categorized by whether antibiotics were administered alone (control) or in conjunction with S. boulardii 20 billion colony-forming units daily (intervention). Associations between S. boulardii administration and HO-CDI incidence was evaluated by multivariate logistic regression. A sub-group analysis evaluated the extent to which administering S. boulardii within or after 24-hours of antibiotic start changed the effect. Propensity scores incorporated to account for selection bias. Results Hospitalizations where S. boulardii was co-administered with antibiotics had a reduced likelihood of HO-CDI (OR = 0.56, 95% CI 0.32 – 0.93) compared with control hospitalizations. S. boulardii administered within 24-hours of antibiotic start had a reduced likelihood of HO-CDI (OR = 0.40, 95% CI 0.21 – 0.75). No effect observed if S. boulardii administered after 24-hours (OR = 0.86, 95% CI 0.45 – 1.64). Post-hoc analysis for disease latency, the average number of days to HO-CDI onset was 5.6, 6.4, and 8.0 days for antibiotic only, S. boulardii after 24-hours, and S. boulardii within 24-hours of antibiotic, respectively (P < 0.04). Conclusion Co-administering S. boulardii with broad-spectrum antibiotics is associated with a reduced risk of C. difficile in hospitalized patients, especially if started within 24-hours of antibiotic initiation. S. boulardii should be considered as preventative intervention to reduce the risk of HO-CDI. Disclosures All authors: No reported disclosures.

scholarly journals Impact of an automatic hospital probiotic protocol on Clostridioides (Clostridium) difficile infection (CDI) rates and CDI antibiotic usage in a community hospital setting

2019 ◽  
Vol 21 (2) ◽  
pp. 72-75
Author(s):  
Douglas Slain ◽  
Amy Georgulis ◽  
Ron Dermitt ◽  
Laura Morris ◽  
Stephen M Colodny
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Community Hospital ◽  
Hospital Setting ◽  
Saccharomyces Boulardii ◽  
Antibiotic Usage ◽  
Oral Vancomycin ◽  
Hospitalised Patients ◽  
Oral Metronidazole

The aim of the present study was to see how widespread preventative use of the probiotic Saccharomyces boulardii via automatic protocol in hospitalised patients receiving antibacterials affected rates of hospital-associated Clostridioides ( Clostridium) difficile infection (HA-CDI). Rates of HA-CDI appeared to be similar between the pre-protocol and protocol periods. Use of CDI treatment antibiotics (oral metronidazole and oral vancomycin) was also similar. Laboratory-confirmed isolation of S. boulardii from sterile body sites was identified in five patients during the protocol versus only one case in the pre-protocol years.

scholarly journals Internal Medicine Resident Perspectives Regarding Broad-Spectrum Antibiotic Usage

2017 ◽  
Vol 4 (2) ◽  
Author(s):  
Ann M. Laake ◽  
Gayle Bernabe ◽  
James Peterson ◽  
Angelike P. Liappis
Keyword(s):  
Internal Medicine ◽  
Adverse Events ◽  
Broad Spectrum ◽  
Internal Medicine Resident ◽  
Antibiotic Usage ◽  
Broad Spectrum Antibiotic ◽  
Diagnostic Uncertainty ◽  
Medicine Resident ◽  
Patient Morbidity ◽  
Internal Medicine Residents

Abstract Focus groups held with internal medicine residents discussed their perspectives regarding broad-spectrum antibiotic (BSA) usage. Residents knew of BSA-associated adverse events, but they did not associate such events with increased patient morbidity and mortality, and they were more likely to use BSA in situations with diagnostic uncertainty and sick patients.

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