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Knudsen MJS, Rubin IMC, Petersen AM. The Clinical Efficacy, Safety, and Tolerability of Vancomycin for the Treatment of Recurrent Clostridioides difficile Infection - A Systematic Review. Drug Healthc Patient Saf 2023; 15:63-71. [PMID: 36974197 PMCID: PMC10039659 DOI: 10.2147/dhps.s348501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/11/2023] [Indexed: 03/29/2023] Open
Abstract
Introduction The aim of this systematic review of randomized clinical trials (RCTs) was to examine the efficacy, safety, and tolerability of vancomycin for treatment of recurrent Clostridioides difficile infection (rCDI). Methods The PubMed database was searched from inception to August 23, 2022. An initial screening was performed followed by a full-text evaluation of the papers. Inclusion criteria were RCTs investigating vancomycin for treatment of rCDI. Results A total of six studies and 269 patients were included in the review. Three studies used a fixed dose regimen of vancomycin, one study used pulse regimen, one study used a taper-and-pulse regimen, and one study used a taper-and-pulse regimen for the participants with two or more recurrences. The resolution of infection varied from 19% to 58.3% in five of six studies reporting this as an outcome. Four out of six studies reported new episodes of rCDI as an intervention outcome, in those studies 50-63% of participants experienced rCDI. Regarding the safety and tolerability of vancomycin treatment for rCDI, one study described several adverse events regarding gastrointestinal discomfort along with fatigue and skin rash. There were no records of serious adverse events in the included studies. Conclusion While oral vancomycin is mostly safe and well tolerated in the RCTs reviewed here, the efficacy for treating rCDI varies greatly from 19-58.3%, and 50-63% of participants experienced new episodes of rCDI.
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Affiliation(s)
- Maja Johanne Søndergaard Knudsen
- Department of Clinical Microbiology, Copenhagen University Hospital – Amager and Hvidovre, Hvidovre, Denmark
- Correspondence: Maja Johanne Søndergaard Knudsen, Email
| | - Ingrid Maria Cecilia Rubin
- Department of Clinical Microbiology, Copenhagen University Hospital – Amager and Hvidovre, Hvidovre, Denmark
| | - Andreas Munk Petersen
- Department of Clinical Microbiology, Copenhagen University Hospital – Amager and Hvidovre, Hvidovre, Denmark
- Department of Gastroenterology, Copenhagen University Hospital – Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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2
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Jones JB, Liu L, Rank LA, Wetzel D, Woods EC, Biok N, Anderson SE, Lee MR, Liu R, Huth S, Sandhu BK, Gellman SH, McBride SM. Cationic Homopolymers Inhibit Spore and Vegetative Cell Growth of Clostridioides difficile. ACS Infect Dis 2021; 7:1236-1247. [PMID: 33739823 PMCID: PMC8130196 DOI: 10.1021/acsinfecdis.0c00843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A wide range of synthetic polymers have been explored for antimicrobial activity. These materials usually contain both cationic and hydrophobic subunits because these two characteristics are prominent among host-defense peptides. Here, we describe a series of nylon-3 polymers containing only cationic subunits and their evaluation against the gastrointestinal, spore-forming pathogen Clostridioides difficile. Despite their highly hydrophilic nature, these homopolymers showed efficacy against both the vegetative and spore forms of the bacterium, including an impact on C. difficile spore germination. The polymer designated P34 demonstrated the greatest efficacy against C. difficile strains, along with low propensities to lyse human red blood cells or intestinal epithelial cells. To gain insight into the mechanism of P34 action, we evaluated several cell-surface mutant strains of C. difficile to determine the impacts on growth, viability, and cell morphology. The results suggest that P34 interacts with the cell wall, resulting in severe cell bending and death in a concentration-dependent manner. The unexpected finding that nylon-3 polymers composed entirely of cationic subunits display significant activities toward C. difficile should expand the range of other polymers considered for antibacterial applications.
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Affiliation(s)
- Joshua B. Jones
- Department of Microbiology and Immunology, Emory University School of Medicine, Emory Antibiotic Resistance Center, Atlanta, GA, USA
| | - Lei Liu
- Department of Chemistry and Department of Medicine, University of Wisconsin, Madison, WI, USA
| | | | - Daniela Wetzel
- Department of Microbiology and Immunology, Emory University School of Medicine, Emory Antibiotic Resistance Center, Atlanta, GA, USA
| | - Emily C. Woods
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Naomi Biok
- Department of Chemistry and Department of Medicine, University of Wisconsin, Madison, WI, USA
| | | | - Myung-ryul Lee
- Department of Chemistry, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Runhui Liu
- State Key Laboratory of Bioreactor Engineering, School of Materials Science and Engineering, East China University of Science and Technology, Shanghai, China
| | - Sean Huth
- Department of Chemistry, Princeton University, Princeton, NJ, USA
| | - Brindar K. Sandhu
- Department of Microbiology and Immunology, Emory University School of Medicine, Emory Antibiotic Resistance Center, Atlanta, GA, USA
| | - Samuel H. Gellman
- Department of Chemistry and Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Shonna M. McBride
- Department of Microbiology and Immunology, Emory University School of Medicine, Emory Antibiotic Resistance Center, Atlanta, GA, USA
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3
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Abstract
Clostridioides difficile remains a leading cause of healthcare-associated infection. Efforts at C. difficile prevention have been hampered by an increasingly complex understanding of transmission patterns and a high degree of heterogeneity among existing studies. Effective prevention of C. difficile infection requires multimodal interventions, including contact precautions, hand hygiene with soap and water, effective environmental cleaning, use of sporicidal cleaning agents, and antimicrobial stewardship. Roles for probiotics, avoidance of proton pump inhibitors, and isolation of asymptomatic carriers remain poorly defined.
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Affiliation(s)
- Nicholas A Turner
- Duke University Medical Center, Department of Medicine, Division of Infectious Diseases, Durham, North Carolina.,Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina
| | - Deverick J Anderson
- Duke University Medical Center, Department of Medicine, Division of Infectious Diseases, Durham, North Carolina.,Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina
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4
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Schultz K, Sickbert-Bennett E, Marx A, Weber DJ, DiBiase LM, Campbell-Bright S, Bode LE, Baker M, Belhorn T, Buchanan M, Goldbach S, Harden J, Hoke E, Huenniger B, Juliano JJ, Langston M, Ritchie H, Rutala WA, Smith J, Summerlin-Long S, Teal L, Gilligan P. Preventable Patient Harm: a Multidisciplinary, Bundled Approach to Reducing Clostridium difficile Infections While Using a Glutamate Dehydrogenase/Toxin Immunochromatographic Assay/Nucleic Acid Amplification Test Diagnostic Algorithm. J Clin Microbiol 2018; 56:e00625-18. [PMID: 29997201 PMCID: PMC6113472 DOI: 10.1128/jcm.00625-18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/05/2018] [Indexed: 12/18/2022] Open
Abstract
Health care facility-onset Clostridium difficile infections (HO-CDI) are an important national problem, causing increased morbidity and mortality. HO-CDI is an important metric for the Center for Medicare and Medicaid Service's (CMS) performance measures. Hospitals that fall into the worst-performing quartile in preventing hospital-acquired infections, including HO-CDI, may lose millions of dollars in reimbursement. Under pressure to reduce CDI and without a clear optimal method for C. difficile detection, health care facilities are questioning how best to use highly sensitive nucleic acid amplification tests (NAATs) to aid in the diagnosis of CDI. Our institution has used a two-step glutamate dehydrogenase (GDH)/toxin immunochromatographic assay/NAAT algorithm since 2009. In 2016, our institution set an organizational goal to reduce our CDI rates by 10% by July 2017. We achieved a statistically significant reduction of 42.7% in our HO-CDI rate by forming a multidisciplinary group to implement and monitor eight key categories of infection prevention interventions over a period of 13 months. Notably, we achieved this reduction without modifying our laboratory algorithm. Significant reductions in CDI rates can be achieved without altering sensitive laboratory testing methods.
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Affiliation(s)
- Katherine Schultz
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | | | - Ashley Marx
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - David J Weber
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
- Division of Adult Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Lauren M DiBiase
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Stacy Campbell-Bright
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Lauren E Bode
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Mike Baker
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Tom Belhorn
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Mark Buchanan
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Sherie Goldbach
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Jacci Harden
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Emily Hoke
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Beth Huenniger
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Jonathan J Juliano
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
- Division of Adult Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Michael Langston
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Heather Ritchie
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - William A Rutala
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Jason Smith
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | | | - Lisa Teal
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Peter Gilligan
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
- Clinical Microbiology-Immunology Laboratories, UNC Health Care, Chapel Hill, North Carolina, USA
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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5
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Abstract
This narrative review summarises the benefits, risks and appropriate use of acid-suppressing drugs (ASDs), proton pump inhibitors and histamine-2 receptor antagonists, advocating a rationale balanced and individualised approach aimed to minimise any serious adverse consequences. It focuses on current controversies on the potential of ASDs to contribute to infections-bacterial, parasitic, fungal, protozoan and viral, particularly in the elderly, comprehensively and critically discusses the growing body of observational literature linking ASD use to a variety of enteric, respiratory, skin and systemic infectious diseases and complications (Clostridium difficile diarrhoea, pneumonia, spontaneous bacterial peritonitis, septicaemia and other). The proposed pathogenic mechanisms of ASD-associated infections (related and unrelated to the inhibition of gastric acid secretion, alterations of the gut microbiome and immunity), and drug-drug interactions are also described. Both probiotics use and correcting vitamin D status may have a significant protective effect decreasing the incidence of ASD-associated infections, especially in the elderly. Despite the limitations of the existing data, the importance of individualised therapy and caution in long-term ASD use considering the balance of benefits and potential harms, factors that may predispose to and actions that may prevent/attenuate adverse effects is evident. A six-step practical algorithm for ASD therapy based on the best available evidence is presented.
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6
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The Phosphotransfer Protein CD1492 Represses Sporulation Initiation in Clostridium difficile. Infect Immun 2016; 84:3434-3444. [PMID: 27647869 DOI: 10.1128/iai.00735-16] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 09/12/2016] [Indexed: 12/18/2022] Open
Abstract
The formation of spores is critical for the survival of Clostridium difficile outside the host gastrointestinal tract. Persistence of C. difficile spores greatly contributes to the spread of C. difficile infection (CDI), and the resistance of spores to antimicrobials facilitates the relapse of infection. Despite the importance of sporulation to C. difficile pathogenesis, the molecular mechanisms controlling spore formation are not well understood. The initiation of sporulation is known to be regulated through activation of the conserved transcription factor Spo0A. Multiple regulators influence Spo0A activation in other species; however, many of these factors are not conserved in C. difficile and few novel factors have been identified. Here, we investigated the function of a protein, CD1492, that is annotated as a kinase and was originally proposed to promote sporulation by directly phosphorylating Spo0A. We found that deletion of CD1492 resulted in increased sporulation, indicating that CD1492 is a negative regulator of sporulation. Accordingly, we observed increased transcription of Spo0A-dependent genes in the CD1492 mutant. Deletion of CD1492 also resulted in decreased toxin production in vitro and in decreased virulence in the hamster model of CDI. Further, the CD1492 mutant demonstrated effects on gene expression that are not associated with Spo0A activation, including lower sigD and rstA transcription, suggesting that this protein interacts with factors other than Spo0A. Altogether, the data indicate that CD1492 negatively affects sporulation and positively influences motility and virulence. These results provide further evidence that C. difficile sporulation is regulated differently from that of other endospore-forming species.
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7
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Edwards AN, Karim ST, Pascual RA, Jowhar LM, Anderson SE, McBride SM. Chemical and Stress Resistances of Clostridium difficile Spores and Vegetative Cells. Front Microbiol 2016; 7:1698. [PMID: 27833595 PMCID: PMC5080291 DOI: 10.3389/fmicb.2016.01698] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 10/12/2016] [Indexed: 12/11/2022] Open
Abstract
Clostridium difficile is a Gram-positive, sporogenic and anaerobic bacterium that causes a potentially fatal colitis. C. difficile enters the body as dormant spores that germinate in the colon to form vegetative cells that secrete toxins and cause the symptoms of infection. During transit through the intestine, some vegetative cells transform into spores, which are more resistant to killing by environmental insults than the vegetative cells. Understanding the inherent resistance properties of the vegetative and spore forms of C. difficile is imperative for the development of methods to target and destroy the bacterium. The objective of this study was to define the chemical and environmental resistance properties of C. difficile vegetative cells and spores. We examined vegetative cell and spore tolerances of three C. difficile strains, including 630Δerm, a 012 ribotype and a derivative of a past epidemic strain; R20291, a 027 ribotype and current epidemic strain; and 5325, a clinical isolate that is a 078 ribotype. All isolates were tested for tolerance to ethanol, oxygen, hydrogen peroxide, butanol, chloroform, heat and sodium hypochlorite (household bleach). Our results indicate that 630Δerm vegetative cells (630 spo0A) are more resistant to oxidative stress than those of R20291 (R20291 spo0A) and 5325 (5325 spo0A). In addition, 5325 spo0A vegetative cells exhibited greater resistance to organic solvents. In contrast, 630Δerm spores were more sensitive than R20291 or 5325 spores to butanol. Spores from all three strains exhibited high levels of resistance to ethanol, hydrogen peroxide, chloroform and heat, although R20291 spores were more resistant to temperatures in the range of 60-75°C. Finally, household bleach served as the only chemical reagent tested that consistently reduced C. difficile vegetative cells and spores of all tested strains. These findings establish conditions that result in vegetative cell and spore elimination and illustrate the resistance of C. difficile to common decontamination methods. These results further demonstrate that the vegetative cells and spores of various C. difficile strains have different resistance properties that may impact decontamination of surfaces and hands.
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Affiliation(s)
- Adrianne N Edwards
- Emory Antibiotic Resistance Center, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta GA, USA
| | - Samiha T Karim
- Emory Antibiotic Resistance Center, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta GA, USA
| | - Ricardo A Pascual
- Emory Antibiotic Resistance Center, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta GA, USA
| | - Lina M Jowhar
- Emory Antibiotic Resistance Center, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta GA, USA
| | - Sarah E Anderson
- Emory Antibiotic Resistance Center, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta GA, USA
| | - Shonna M McBride
- Emory Antibiotic Resistance Center, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta GA, USA
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8
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Hebbard AIT, Slavin MA, Reed C, Teh BW, Thursky KA, Trubiano JA, Worth LJ. The epidemiology of Clostridium difficile infection in patients with cancer. Expert Rev Anti Infect Ther 2016; 14:1077-1085. [PMID: 27606976 DOI: 10.1080/14787210.2016.1234376] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Clostridium difficile infection (CDI) is a significant cause of healthcare-associated diarrhoea, and the emergence of endemic strains resulting in poorer outcomes is recognised worldwide. Patients with cancer are a specific high-risk group for development of infection. Areas covered: In this review, modifiable and non-modifiable risk factors for CDI in adult patients with haematological malignancy or solid tumours are evaluated. In particular, the contribution of antimicrobial exposure, hospitalisation and gastric acid suppression to risk of CDI are discussed. Recent advances in CDI treatment are outlined, namely faecal microbiota transplantation and fidaxomicin therapy for severe/refractory infection in cancer populations. Outcomes of CDI, including mortality are presented, together with the need for valid severity rating tools customised for cancer populations. Expert commentary: Future areas for research include the prognostic value of C. difficile colonisation in cancer patients and the potential impact of dedicated antimicrobial stewardship programs in reducing the burden of CDI in cancer units.
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Affiliation(s)
- Andrew I T Hebbard
- a Department of Infectious Diseases and Infection Prevention , Peter MacCallum Cancer Centre , Melbourne , Australia
| | - Monica A Slavin
- a Department of Infectious Diseases and Infection Prevention , Peter MacCallum Cancer Centre , Melbourne , Australia.,b Department of Medicine , University of Melbourne , Melbourne , Australia
| | - Caroline Reed
- c Microbiology Department , Peter MacCallum Cancer Centre , Melbourne , Australia
| | - Benjamin W Teh
- a Department of Infectious Diseases and Infection Prevention , Peter MacCallum Cancer Centre , Melbourne , Australia
| | - Karin A Thursky
- a Department of Infectious Diseases and Infection Prevention , Peter MacCallum Cancer Centre , Melbourne , Australia
| | - Jason A Trubiano
- a Department of Infectious Diseases and Infection Prevention , Peter MacCallum Cancer Centre , Melbourne , Australia
| | - Leon J Worth
- a Department of Infectious Diseases and Infection Prevention , Peter MacCallum Cancer Centre , Melbourne , Australia.,b Department of Medicine , University of Melbourne , Melbourne , Australia.,d Victorian Healthcare Associated Infection Surveillance System (VICNISS) , Doherty Institute , Melbourne , Australia
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9
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Ghantoji SS, Stibich M, Stachowiak J, Cantu S, Adachi JA, Raad II, Chemaly RF. Non-inferiority of pulsed xenon UV light versus bleach for reducing environmental Clostridium difficile contamination on high-touch surfaces in Clostridium difficile infection isolation rooms. J Med Microbiol 2015; 64:191-4. [PMID: 25627208 DOI: 10.1099/jmm.0.000004-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The standard for Clostridium difficile surface decontamination is bleach solution at a concentration of 10 % of sodium hypochlorite. Pulsed xenon UV light (PX-UV) is a means of quickly producing germicidal UV that has been shown to be effective in reducing environmental contamination by C. difficile spores. The purpose of this study was to investigate whether PX-UV was equivalent to bleach for decontamination of surfaces in C. difficile infection isolation rooms. High-touch surfaces in rooms previously occupied by C. difficile infected patients were sampled after discharge but before and after cleaning using either bleach or non-bleach cleaning followed by 15 min of PX-UV treatment. A total of 298 samples were collected by using a moistened wipe specifically designed for the removal of spores. Prior to disinfection, the mean contamination level was 2.39 c.f.u. for bleach rooms and 22.97 for UV rooms. After disinfection, the mean level of contamination for bleach was 0.71 c.f.u. (P = 0.1380), and 1.19 c.f.u. (P = 0.0017) for PX-UV disinfected rooms. The difference in final contamination levels between the two cleaning protocols was not significantly different (P = 0.9838). PX-UV disinfection appears to be at least equivalent to bleach in the ability to decrease environmental contamination with C. difficile spores. Larger studies are needed to validate this conclusion.
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Affiliation(s)
- Shashank S Ghantoji
- University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd/Box 402, Houston, TX 77030, USA
| | - Mark Stibich
- Xenex Disinfection Services, 121 Interpark, Suite 104, San Antonio, Texas, 78216, USA
| | - Julie Stachowiak
- Xenex Disinfection Services, 121 Interpark, Suite 104, San Antonio, Texas, 78216, USA
| | - Sherry Cantu
- University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd/Box 402, Houston, TX 77030, USA
| | - Javier A Adachi
- University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd/Box 402, Houston, TX 77030, USA
| | - Issam I Raad
- University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd/Box 402, Houston, TX 77030, USA
| | - Roy F Chemaly
- University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd/Box 402, Houston, TX 77030, USA
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10
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Ghantoji SS, Stibich M, Stachowiak J, Cantu S, Adachi JA, Raad II, Chemaly RF. Non-inferiority of pulsed xenon UV light versus bleach for reducing environmental Clostridium difficile contamination on high-touch surfaces in Clostridium difficile infection isolation rooms. J Med Microbiol 2015. [DOI: 10.1099/jmm.0.000004] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Shashank S. Ghantoji
- University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd/Box 402, Houston, TX 77030, USA
| | - Mark Stibich
- Xenex Disinfection Services, 121 Interpark, Suite 104, San Antonio, Texas, 78216, USA
| | - Julie Stachowiak
- Xenex Disinfection Services, 121 Interpark, Suite 104, San Antonio, Texas, 78216, USA
| | - Sherry Cantu
- University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd/Box 402, Houston, TX 77030, USA
| | - Javier A. Adachi
- University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd/Box 402, Houston, TX 77030, USA
| | - Issam I. Raad
- University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd/Box 402, Houston, TX 77030, USA
| | - Roy F. Chemaly
- University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd/Box 402, Houston, TX 77030, USA
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11
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Antibiotic stewardship challenges in the management of community-acquired infections for prevention of escalating antibiotic resistance. J Glob Antimicrob Resist 2014; 2:245-253. [DOI: 10.1016/j.jgar.2014.08.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 07/28/2014] [Accepted: 08/05/2014] [Indexed: 11/20/2022] Open
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12
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Marković V, Kostić M, Iličković I, Janković SM. Cost-Effectiveness Comparison of Fidaxomicin and Vancomycin for Treatment of Clostridium difficile Infection: A Markov Model Based on Data from a South West Balkan Country in Socioeconomic Transition. Value Health Reg Issues 2014; 4:87-94. [PMID: 29702813 DOI: 10.1016/j.vhri.2014.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Recent studies have shown that fidaxomicin, a novel antibiotic, can reduce the rate of complications and mortality in patients with colitis induced by Clostridium difficile. Introduction of fidaxomicin in clinical practice is limited by its high costs. OBJECTIVES The purpose of this study was to estimate the cost effectiveness of using fidaxomicin versus vancomycin in patients with colitis induced by C. difficile who did not respond to oral metronidazole. METHODS We constructed a Markov model that was than simulated by Monte-Carlo simulation using 1000 virtual patients with colitis induced by C. difficile. The perspective in our model was institutional. The time horizon was 3 months. Values of transition probabilities and therapy outcomes were estimated from the available literature, the prices of health services were obtained from the Republic Institute for Health Insurance Tariff Book, and the price of fidaxomicin was derived from data gained from the drug manufacturer. RESULTS The total costs of treating one statistical patient for 3 months with fidaxomicin were higher (48,106.19 ± 118.07 Republic of Serbia dinars [RSD]; 95% confidence interval 47,988.12-48,224.27) than the total costs of treating with vancomycin (25,872.85 ± 41.44 RSD; 95% confidence interval 25,831.41-25,914.29). Our results showed that the treatment of infections induced by C. difficile with fidaxomicin correlated with a lower rate of mortality and with a smaller number of colectomies. The incremental cost-effectiveness ratio of fidaxomicin versus vancomycin for colitis induced by C. difficile per saved life was estimated at 2.97 million RSD and for one avoided colectomy at 10.07 million RSD. CONCLUSIONS Results of our model indicate that fidaxomicin is a cost-effective therapy compared with vancomycin in patients with colitis induced by C. difficile if the outcome is life-year saved. However, if the outcome is the number of avoided colectomies, then fidaxomycin is not a cost-effective option compared with vancomycin.
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Affiliation(s)
- Veroljub Marković
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Marina Kostić
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.
| | - Ivana Iličković
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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13
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Arneson W. Electrolytes: The Salts of the Earth. Lab Med 2014. [DOI: 10.1309/lm24gwiuexokn7ap] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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14
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Barletta JF, El-Ibiary SY, Davis LE, Nguyen B, Raney CR. Proton Pump Inhibitors and the Risk for Hospital-Acquired Clostridium difficile Infection. Mayo Clin Proc 2013; 88:1085-90. [PMID: 24012413 DOI: 10.1016/j.mayocp.2013.07.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 06/25/2013] [Accepted: 07/01/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To examine the relationship between proton pump inhibitor (PPI) usage and nosocomial Clostridium difficile infection (CDI) and determine the duration of therapy at which CDI risk increases. PATIENTS AND METHODS This retrospective case-control study included consecutive adult patients in whom nosocomial CDI developed after hospitalization for 3 or more days at one of 2 affiliated hospitals between June 1, 2010, and October 31, 2011. These patients were matched to patients hospitalized within 6 months who did not have CDI development in a 1:2 ratio using age, sex, and antibiotic usage. Potential risk factors for CDI, including PPI use and duration, were evaluated. Multivariate analysis was performed to control for confounding variables and identify risk factors. RESULTS A total of 201 patients were evaluated, 67 with CDI and 134 matched controls. Patients in whom CDI developed were more likely to have received a PPI (76% vs 39%; P<.001) and had a longer duration of PPI therapy (median [range], 5 [0-20] days vs 0 [0-11] days; P<.001) than those who did not have CDI development. After controlling for prior hospital admission, intensive care unit admission, admission from a skilled nursing facility, immunosuppression, number of antibiotics received, PPI duration, and time to event via multivariate analysis, PPI duration was found to be a risk factor for CDI (odds ratio, 1.14; 95% CI, 1.02-1.27; P=.018). The probability for CDI was higher when PPI use exceeded 2 days in patients without a prior hospital admission and 1 day in patients with a prior admission. CONCLUSION The duration of PPI therapy is significantly associated with CDI. Clinicians should strongly consider restricting PPI use given the short exposure time associated with this increased risk.
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Affiliation(s)
- Jeffrey F Barletta
- Department of Pharmacy Practice, Midwestern University College of Pharmacy-Glendale, Glendale, AZ.
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15
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O'Horo JC, Jindai K, Kunzer B, Safdar N. Treatment of recurrent Clostridium difficile infection: a systematic review. Infection 2013; 42:43-59. [PMID: 23839210 DOI: 10.1007/s15010-013-0496-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Accepted: 06/12/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Clostridium difficile infection (CDI) recurs in nearly one-third of patients who develop an initial infection. Recurrent CDI (RCDI) is associated with considerable morbidity, mortality, and cost. Treatment for RCDI has not been not well examined. METHODS A systematic review. RESULTS Sixty-four articles were identified evaluating eight different treatment approaches: metronidazole, vancomycin, fidaxomicin, nitazoxanide, rifampin, immunoglobulins, probiotics, and fecal bacteriotherapy. The meta-analysis found vancomycin to have a similar efficacy to metronidazole, although studies used varying doses and durations of therapy. Fidaxomicin was slightly more efficacious than vancomycin, though the number of studies was small. Good evidence for probiotics was limited. Fecal bacteriotherapy was found to be highly efficacious in a single randomized trial. CONCLUSION Metronidazole and vancomycin have good evidence for use in RCDI but heterogeneity in treatment duration and dose precludes robust conclusions. Fidaxomicin may have a role in treatment, but evidence is limited to subgroup analyses. Fecal bacteriotherapy was the most efficacious. Saccharomyces boulardii may have a role as adjunctive treatment.
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Affiliation(s)
- J C O'Horo
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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Agha M. Epidemiology and Pathogenesis of C. difficile and MRSA in the Light of Current NHS Control Policies: A Policy review. Ann Med Surg (Lond) 2012; 1:39-43. [PMID: 26257907 PMCID: PMC4523159 DOI: 10.1016/s2049-0801(12)70012-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 08/20/2012] [Indexed: 11/01/2022] Open
Abstract
Healthcare associated infections (HCAIs) cause significant morbidity and mortality, and are estimated to cost the United Kingdom National Health Service £1 billion annually. The current health care infection rates suggest that the level of performance to avoid HCAIs is not maintained consistently. Increasing screening, improving local accountability and performance management, careful use of antibiotics in the management of emergency patients, health economy wide approaches, and improved hand washing will be effective in lowering the rate of HCAIs. This paper reviews current NHS Control Policies in place for Methicillin Resistant Staphylococcus Aureus (MRSA) and C. difficile.
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Affiliation(s)
- Maliha Agha
- Department of primary care and public health, King's College London, London, UK
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