Adherence to and Outcomes Associated with a Clostridium difficile Guideline at a Large Teaching Institution.
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The incidence and virulence of Clostridium difficile infection (CDI) has recently increased. National CDI treatment guidelines stratify patients based on clinical symptoms and recommend treatment based on severity of illness. In 2009, Advocate Lutheran General Hospital (Park Ridge, Illinois) adopted guidelines with treatment algorithms identical to the national guidelines. The purpose of this study was to determine whether patients were being treated in accordance with the CDI guidelines and whether adherence impacted patient outcomes.This was a retrospective, descriptive study. Subjects were identified by CDI-associated ICD-9 codes from July 1, 2009 to June 30, 2011 and stratified by disease severity. Guideline adherence was assessed based on initial treatment selection, and subjects were then further categorized as undertreated (UT), overtreated (OT), or appropriately treated (AT). Secondary endpoints included need for therapy escalation, clinical cure, recurrence rates, 90-day all-cause mortality, proton pump inhibitor (PPI), and antimicrobial use.Two hundred fifty subjects totaling 324 encounters were analyzed. Overall guideline adherence was 42.9%. Adherence rates by CDI severity were mild-moderate, 53.9%; severe, 39.0%; and severe-complicated, 17.9% (P < .001). Of all the subjects, 42.9% were AT, 30.9% were OT, and 26.2% were UT. Clinical outcomes between UT versus AT subjects were as follows: therapy escalation required, 34.1% versus 27.5% (P = .289); clinical cure, 41.2% versus 55.7% (P = .033); mortality, 24.7% versus 10.1% (P = .003); and recurrence, 44.7% versus 24.8% (P < .02). Clinical outcomes between AT versus OT subjects were as follows: therapy escalation required 27.5% versus 14.4% (P < .02); clinical cure, 55.7% versus 66.7% (P = .089); mortality, 10.1% versus 7.8% (P = .553); recurrence, 24.8% versus 27.8% (P = .871).The majority of subjects were not treated according to CDI guidelines, particularly those with severe and severe-complicated disease. UT subjects had worse clinical outcomes and OT subjects failed to show significant improvements in clinical outcomes compared to AT subjects. Emphasis should be placed on CDI guideline adherence as this may be associated with improved outcomes.Keywords:
Guideline
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Objectives: Clostridium difficile infection (CDI) is the single most common cause of nosocomial diarrhea in both adults and children; however, available data regarding the incidence and associated risk factors in hospitalized children remains limited. This study aimed to determine the incidence of CDI and its associated risk factors. The secondary objectives are to evaluate treatment protocols (cured, failure, recurrence), associated outcomes, and the importance of antibiotic stewardship to reduce the risk of CDI. Methods: A retrospective …
Antimicrobial Stewardship
Enterocolitis
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Introduction. Adherence to proposed lifestyle changes and prescribed medication in patients with stable coronary artery disease (SCAD) is poor. Objective. We sought to investigate the influence of adjusting guideline proposed medications on relief of angina in a large group of patients with SCAD in Serbia. Methods. The study included a total of 3,490 patients from 15 cardiology clinics with symptoms of stable angina and at least one of the following criteria: abnormal electrocardiogram (ECG), history of myocardial infarction (MI), positive stress test, significant coronary artery disease on coronary angiogram or previous revascularization. All the patients underwent comprehensive evaluation at initial visit and after two months. The relief of angina was study end-point defined as any reduction in Canadian Cardiology Society (CCS) class, number of angina attacks per week and/or number of tablets of short-acting nitrates per week. Results. Most patients were included based on abnormal ECG (48.4%). At Visit 1, the average number of prescribed classes of medications to a single patient increased from 4.16 ? 1.29 to 4.63 ? 1.57 (p < 0.001). At the follow-up, the patients had significantly lower blood pressure (141 ? 19 / 85 ? 11 vs. 130 ? 12 / 80 ? 8 mmHg; p < 0.001) and most of them reported CCS class I (63.3%). The average weekly number of angina attacks was reduced from 2.82 ? 2.50 at Visit 1 to 1.72 0 ? 1.66 at Visit 2, as well as average weekly use of short-acting nitrates to treat these attacks (2.69 ? 2.53 to 1.74 ? 1.47 tablets; p < 0.001 for all). Conclusion. Adjustment of prescribed medications to guideline recommendations in a large Serbian patient population with prevalent risk factors led to significant relief of angina.
Canadian Cardiovascular Society
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Journal Article Incidence, aetiology, diagnosis, and prognosis of closed abdominal injuries, A study of 265 consecutive cases Get access David H Wilson David H Wilson Research Assistant The Casualty Department of the General Infirmary at Leeds Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 50, Issue 222, January 1963, Pages 381–389, https://doi.org/10.1002/bjs.18005022206 Published: 06 December 2005
Etiology
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OBJECTIVE: To evaluate the risk factors, incidence, and morbidity associated with the diagnosis of obstetric Clostridium difficile infection. METHODS: We performed a retrospective cohort study on women admitted for delivery using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from the United States. The delivery admission records of pregnant women were reviewed between 1999 and 2013. After adjusting for demographic and clinical characteristics, we assessed risk factors for the diagnosis of C difficile infection using unconditional logistic regression. RESULTS: Of the total 13,881,592 births in our cohort, we identified 2,757 (0.02%) admissions for delivery complicated by a diagnosis of C difficile infection. During the study period, the rate of C difficile infection diagnoses among women hospitalized for delivery doubled from 15 (95% CI 11.87–16.96) to 30 (24.42–31.78) per 100,000 deliveries per year ( P <.001). Risk factors associated with the diagnosis of C difficile infection included age older than 35 years, multiple gestations, smoking, Crohn's disease, ulcerative colitis, long-term antibiotic use, pneumonia, pyelonephritis as well as cesarean or perineal wound infection. The diagnosis of C difficile infection in pregnancy was associated with a significant increase in maternal death (8.0/1,000 vs 0.1/1,000, adjusted odds ratio [OR] 56.8, 95% CI 35.8–90.1). Furthermore, there was an increase in sepsis (46.4/1,000 vs 0.6/1,000, adjusted OR 59.1, 95% CI 48.8–71.6), paralytic ileus (58.0/1,000 vs 1.5/1,000, adjusted OR 33.1, 95% CI 27.5–39.8), venous thromboembolism (38.4/1,000 vs 3.1/1,000, adjusted OR 8.1, 95% CI 6.5–10.2), and hospital stays greater than 2 weeks (173.0/1,000 vs 6.5,1,000, adjusted OR 24.3, 95% CI 21.6–27.4) among pregnant women with C difficile infection. CONCLUSION: The diagnosis of C difficile infections in pregnancy has increased over the past 15 years and this diagnosis is associated with significant maternal morbidity and mortality.
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