scholarly journals Management of antibiotic related and clostridium difficile colitis

2014 ◽  
Vol 61 (2) ◽  
pp. 65-70
Author(s):  
Najib Haboubi ◽  
Zoran Krivokapic
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Broad Spectrum ◽  
Bowel Perforation ◽  
Systemic Infection ◽  
The Elderly ◽  
Causative Agents ◽  
Life Threatening ◽  
Clostridium Difficile Colitis ◽  
First Recurrence

Nearly all antibiotics can cause some form of diarrhoea. Clostridium difficile infection has become an important area in our daily clinical practice and is known to cause a broad spectrum of conditions ranging from asymptomatic carriage to the life-threatening pseudomembranous colitis (PMC), with toxic megacolon and ileus. Patients most at risk are those who have been treated with broad spectrum antibiotics, those with serious underlying co-morbidities and the elderly. Over 80% of Clostridium difficile infection reported are in people aged over 65 years. Combination of rapid and accurate diagnosis will result in a better management of Clostridium difficile infection. Discontinuation of causative agents such as antibiotic treatment is often curative. In more serious cases, oral administration of metronidazole or vancomycin is the treatment of choice. Patients should be treated promptly when the diagnosis of Clostridium difficile colitis is made to avoid sepsis or bowel perforation. Relapses of Clostridium difficile infection have been reported in about 20-25% of cases, this may increase to 45-60% after the first recurrence on. In some cases colectomy may improve the outcome of the patient with systemic infection or complicated Clostridium difficile colitis. This article reviews the current literature regarding epidemiological picture, microbiology, histopathology and both medical and surgical managements.

P196: Clostridium difficile infection – serious problem for the elderly?

2014 ◽  
Vol 5 ◽  
pp. S145-S146
Author(s):  
K. Bielakova ◽  
H. Matejovská-Kubešová ◽  
P. Weber ◽  
D. Weberová
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
The Elderly

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.

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 Treatment of First Recurrence of Clostridium difficile Infection: Fidaxomicin Versus Vancomycin

2012 ◽  
Vol 55 (suppl 2) ◽  
pp. S154-S161 ◽  
Author(s):  
O. A. Cornely ◽  
M. A. Miller ◽  
T. J. Louie ◽  
D. W. Crook ◽  
S. L. Gorbach
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
First Recurrence

scholarly journals Predictors of Mortality Among a National Cohort of Veterans With Recurrent Clostridium difficile Infection

2018 ◽  
Vol 5 (8) ◽  
Author(s):  
Haley J Appaneal ◽  
Aisling R Caffrey ◽  
Maya Beganovic ◽  
Sanja Avramovic ◽  
Kerry L LaPlante
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Control Analysis ◽  
Predictors Of Mortality ◽  
Risk Of Death ◽  
The Third ◽  
Recurrent Clostridium Difficile Infection ◽  
All Cause Mortality ◽  
National Cohort ◽  
First Recurrence

Abstract Background Though recurrent Clostridium difficile infection (CDI) is common and poses a major clinical concern, data are lacking regarding mortality among patients who survive their initial CDI and have subsequent recurrences. Risk factors for mortality in patients with recurrent CDI are largely unknown. Methods Veterans Affairs patients with a first CDI (stool sample with positive C. difficile toxin(s) and ≥2 days CDI treatment) were included (2010–2014). Subsequent recurrences were defined as additional CDI episodes ≥14 days after the stool test date and within 30 days of the end of treatment. A matched (1:4) case–control analysis was conducted using multivariable conditional logistic regression to identify predictors of all-cause mortality within 30 days of the first recurrence. Results Crude 30-day all-cause mortality rates were 10.6% for the initial CDI episode, 8.3% for the first recurrence, 4.2% for the second recurrence, and 5.9% for the third recurrence. Among 110 cases and 440 controls, 6 predictors of mortality were identified: use of proton pump inhibitors (PPIs; odds ratio [OR], 3.86; 95% confidence interval [CI], 2.14–6.96), any antibiotic (OR, 3.33; 95% CI, 1.79–6.17), respiratory failure (OR, 8.26; 95% CI, 1.71–39.92), congitive dysfunction (OR, 2.41; 95% CI, 1.02–5.72), nutrition deficiency (OR, 2.91; 95% CI, 1.37–6.21), and age (OR, 1.04; 95% CI, 1.01–1.07). Conclusions In our national cohort of Veterans, crude mortality decreased by 44% from the initial episode to the third recurrence. Treatment with antibiotics, use of PPIs, and underlying comorbidities were important predictors of mortality in recurrent CDI. Our study assists health care providers in identifying patients at high risk of death after CDI recurrence.

scholarly journals Clinical characterization and risk factors of Clostridium difficile infection in elderly patients in a Chinese hospital

2015 ◽  
Vol 9 (04) ◽  
pp. 381-387 ◽  
Author(s):  
Zhang Lihua ◽  
Dong Danfeng ◽  
Jiang Cen ◽  
Wang Xuefeng ◽  
Peng Yibing
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Elderly Patients ◽  
Clinical Features ◽  
Clostridium Difficile Infection ◽  
Gastrointestinal Disease ◽  
Statistical Tests ◽  
The Elderly ◽  
Hospitalized Patients ◽  
Elderly Hospitalized Patients

Introduction: Clostridium difficile is a common cause of nosocomial diarrhea, especially in elderly patients. This study aimed to analyze the clinical features and assess the risk factors associated with Clostridium difficile infection (CDI) in elderly hospitalized patients. Methodology: A retrospective case-control study was conducted among elderly hospitalized patients (> 60 years of age) in a Chinese tertiary hospital between 2010 and 2013. Fifty-two CDI patients and 150 randomly selected non-CDI patients were included in the study. Clinical features of CDI and non-CDI patients were compared by appropriate statistical tests. Logistic regression analyses were performed on a series of factors to determine the risk factors for CDI among the elderly hospitalized patients. Results: The elderly CDI patients showed higher leukocyte counts, lower serum albumin levels, longer duration of hospital stay, and higher mortality compared to the non-CDI patients. The proportion of patients admitted to the intensive care unit or exposed to gastric acid suppressants was also significantly different (p < 0.05) between the two groups. Multivariate analysis indicated that serum creatinine (OR 1.004; 95% CI 1.001–1.008), surgical intervention (OR 6.132; 95% CI 2.594–14.493), the number of comorbidities (OR 2.573; 95% CI 1.353–4.892), gastrointestinal disease (OR 4.670; 95% CI 2.002–10.895), and antibiotic use (OR 6.718; 95% CI 2.846–15.859) were independently associated with CDI. Conclusions: This study revealed several risk factors for CDI among elderly hospitalized patients. These findings will increase the knowledge concerning this disease and provide information regarding the control and prevention of CDI in the elderly.

Sign in / Sign up

Export Citation Format

Share Document