Ali Elbeddini1, Rachel Gerochi2. 1. Winchester District Memorial Hospital, 566 Louise Street, Winchester, ON, KK0C2K0, Canada. elbeddini.a@gmail.com. 2. Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, M5S 3M2, Canada.
Abstract
OBJECTIVES: Clostridium difficile infection (CDI) is responsible for 15-25% cases of health-care-associated diarrhea. The CDI treatment algorithm used at our hospital is adapted from the Infectious Diseases Society of America 2010 C. difficile guideline. The primary objective of this study was to assess the treatment adherence to our algorithm; this was defined as therapy consisting of the appropriate antibiotic, dose, route, interval, and duration indicated based on the disease severity and episode within 24 h of diagnosis. Furthermore, our study also described the population and their risk factors for CDI at our hospital. METHODS: This was a single-centre, retrospective cohort chart review of CDI cases that were diagnosed at admission or during hospitalization from June 1st, 2017 to June 30th, 2018. Cases were identified by a positive stool test along with watery diarrhea or by colonoscopy. RESULTS: Sixty cases were included, of which adherence to our algorithm was 50%. Overall, severe CDI had the highest treatment non-adherence (83%), and the biggest contributing factor was prescribing the wrong antibiotic (72%). In severe CDI, which warrants vancomycin monotherapy, wrong antibiotic consisted of metronidazole monotherapy (55%) or dual therapy with metronidazole and vancomycin (45%). Patients were mostly older, females being treated for an initial episode of mild-to-moderate CDI. Common risk factors identified were age over 65 years (80%), use of antibiotics (83%) and proton pump inhibitors (PPI) (68%) within the previous 3 months. The use of a PPI in this study, a modifiable risk factor without a clear indication, was 35%. CONCLUSION: An area for antimicrobial stewardship intervention in CDI treatment at our hospital is prescribing the right antibiotic based on the CDI indication. In severe CDI, an emphasis should be on prescribing vancomycin monotherapy as the drug of choice. PPI use should be reassessed for tapering when appropriate.
OBJECTIVES:Clostridium difficileinfection (CDI) is responsible for 15-25% cases of health-care-associated diarrhea. The CDI treatment algorithm used at our hospital is adapted from the Infectious Diseases Society of America 2010 C. difficile guideline. The primary objective of this study was to assess the treatment adherence to our algorithm; this was defined as therapy consisting of the appropriate antibiotic, dose, route, interval, and duration indicated based on the disease severity and episode within 24 h of diagnosis. Furthermore, our study also described the population and their risk factors for CDI at our hospital. METHODS: This was a single-centre, retrospective cohort chart review of CDI cases that were diagnosed at admission or during hospitalization from June 1st, 2017 to June 30th, 2018. Cases were identified by a positive stool test along with watery diarrhea or by colonoscopy. RESULTS: Sixty cases were included, of which adherence to our algorithm was 50%. Overall, severe CDI had the highest treatment non-adherence (83%), and the biggest contributing factor was prescribing the wrong antibiotic (72%). In severe CDI, which warrants vancomycin monotherapy, wrong antibiotic consisted of metronidazole monotherapy (55%) or dual therapy with metronidazole and vancomycin (45%). Patients were mostly older, females being treated for an initial episode of mild-to-moderate CDI. Common risk factors identified were age over 65 years (80%), use of antibiotics (83%) and proton pump inhibitors (PPI) (68%) within the previous 3 months. The use of a PPI in this study, a modifiable risk factor without a clear indication, was 35%. CONCLUSION: An area for antimicrobial stewardship intervention in CDI treatment at our hospital is prescribing the right antibiotic based on the CDI indication. In severe CDI, an emphasis should be on prescribing vancomycin monotherapy as the drug of choice. PPI use should be reassessed for tapering when appropriate.
Entities:
Keywords:
Adherence; Algorithm; Clostridium difficile infection; Infectious Diseases Society of America 2010 C. difficile guideline; Metronidazole; Vancomycin
Authors: Christina M Surawicz; Lawrence J Brandt; David G Binion; Ashwin N Ananthakrishnan; Scott R Curry; Peter H Gilligan; Lynne V McFarland; Mark Mellow; Brian S Zuckerbraun Journal: Am J Gastroenterol Date: 2013-02-26 Impact factor: 10.864
Authors: I Patel; M Wungjiranirun; T Theethira; J Villafuerte-Galvez; N Castillo; M Akbari; C D Alonso; D A Leffler; C P Kelly Journal: J Antimicrob Chemother Date: 2016-11-14 Impact factor: 5.790
Authors: Vanessa W Stevens; Cary Thurm; Elyse M Schwab; Matthew P Kronman; Jeffrey S Gerber; Samir S Shah; Jason G Newland; Joshua Courter; Sarah Parker; Thomas V Brogan; Adam L Hersh Journal: Infect Dis Ther Date: 2016-03-14