Megan M Seddon1,2, P Brandon Bookstaver1,2, Julie Ann Justo1,2, Joseph Kohn2, Hana Rac1, Emily Haggard3, Krutika N Mediwala4, Sangita Dash5,6, Majdi N Al-Hasan5,6. 1. University of South Carolina College of Pharmacy, Columbia. 2. Palmetto Health Richland, Columbia. 3. Palmetto Health Baptist, Columbia. 4. Palmetto Health Baptist Parkridge, Columbia. 5. University of South Carolina School of Medicine, Palmetto Health University of South Carolina Medical Group, Columbia. 6. Department of Medicine, Division of Infectious Diseases, Palmetto Health University of South Carolina Medical Group, Columbia.
Abstract
BACKGROUND: There is a paucity of data on the effect of early de-escalation of antimicrobial therapy on rates of Clostridioides difficile infection (CDI). This retrospective cohort study evaluated impact of de-escalation from antipseudomonal β-lactam (APBL) therapy within 48 hours of Enterobacteriaceae bloodstream infections (BSIs) on 90-day risk of CDI. METHODS: Adult patients hospitalized for >48 hours for treatment of Enterobacteriaceae BSI at Palmetto Health hospitals in Columbia, South Carolina, from 1 January 2011 through 30 June 2015 were identified. Multivariable Cox proportional hazards regression was used to examine time to CDI in patients who received >48 hours or ≤48 hours of APBL for empirical therapy of Enterobacteriaceae BSI after adjustment for the propensity to receive >48 hours of APBL. RESULTS: Among 808 patients with Enterobacteriaceae BSI, 414 and 394 received >48 and ≤48 hours of APBL, respectively. Incidence of CDI was higher in patients who received >48 hours than those who received ≤48 hours of APBL (7.0% vs 1.8%; log-rank P = .002). After adjustment for propensity to receive >48 hours of APBL and other variables in the multivariable model, receipt of >48 hours of APBL (hazard ratio [HR], 3.56 [95% confidence interval {CI}, 1.48-9.92]; P = .004) and end-stage renal disease (HR, 4.27 [95% CI, 1.89-9.11]; P = .001) were independently associated with higher risk of CDI. CONCLUSIONS: The empirical use of APBL for >48 hours was an independent risk factor for CDI. Early de-escalation of APBL using clinical risk assessment tools or rapid diagnostic testing may reduce the incidence of CDI in hospitalized adults with Enterobacteriaceae BSIs.
BACKGROUND: There is a paucity of data on the effect of early de-escalation of antimicrobial therapy on rates of Clostridioides difficile infection (CDI). This retrospective cohort study evaluated impact of de-escalation from antipseudomonal β-lactam (APBL) therapy within 48 hours of Enterobacteriaceae bloodstream infections (BSIs) on 90-day risk of CDI. METHODS: Adult patients hospitalized for >48 hours for treatment of Enterobacteriaceae BSI at Palmetto Health hospitals in Columbia, South Carolina, from 1 January 2011 through 30 June 2015 were identified. Multivariable Cox proportional hazards regression was used to examine time to CDI in patients who received >48 hours or ≤48 hours of APBL for empirical therapy of Enterobacteriaceae BSI after adjustment for the propensity to receive >48 hours of APBL. RESULTS: Among 808 patients with Enterobacteriaceae BSI, 414 and 394 received >48 and ≤48 hours of APBL, respectively. Incidence of CDI was higher in patients who received >48 hours than those who received ≤48 hours of APBL (7.0% vs 1.8%; log-rank P = .002). After adjustment for propensity to receive >48 hours of APBL and other variables in the multivariable model, receipt of >48 hours of APBL (hazard ratio [HR], 3.56 [95% confidence interval {CI}, 1.48-9.92]; P = .004) and end-stage renal disease (HR, 4.27 [95% CI, 1.89-9.11]; P = .001) were independently associated with higher risk of CDI. CONCLUSIONS: The empirical use of APBL for >48 hours was an independent risk factor for CDI. Early de-escalation of APBL using clinical risk assessment tools or rapid diagnostic testing may reduce the incidence of CDI in hospitalized adults with Enterobacteriaceae BSIs.
Authors: Nicole C Vissichelli; Christine M Orndahl; Jane A Cecil; Emily M Hill; Matthew M Hitchcock; Roy T Sabo; Michael P Stevens; Dan Tassone; Leroy B Vaughan; J Daniel Markley Journal: Infect Control Hosp Epidemiol Date: 2021-04-06 Impact factor: 6.520
Authors: Stephanie C Shealy; Christine Alexander; Tina Grof Hardison; Joseph Magagnoli; Julie Ann Justo; Caroline Derrick; Joseph Kohn; Hana Rac Winders; Troy Privette; Majdi N Al-Hasan; P Brandon Bookstaver Journal: Pharmacy (Basel) Date: 2020-04-23
Authors: Max W Adelman; Michael H Woodworth; Virginia O Shaffer; Greg S Martin; Colleen S Kraft Journal: Crit Care Med Date: 2021-01-01 Impact factor: 9.296