PMID- 33568232
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20210214
IS  - 2052-3211 (Print)
IS  - 2052-3211 (Electronic)
IS  - 2052-3211 (Linking)
VI  - 14
IP  - 1
DP  - 2021 Feb 11
TI  - Treatment of Clostridium difficile infection in community teaching hospital: a 
      retrospective study.
PG  - 19
LID - 10.1186/s40545-020-00289-1 [doi]
LID - 19
AB  - 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.
FAU - Elbeddini, Ali
AU  - Elbeddini A
AUID- ORCID: 0000-0002-3339-6203
AD  - Winchester District Memorial Hospital, 566 Louise Street, Winchester, ON, 
      KK0C2K0, Canada. elbeddini.a@gmail.com.
FAU - Gerochi, Rachel
AU  - Gerochi R
AD  - Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, 
      M5S 3M2, Canada.
LA  - eng
PT  - Journal Article
DEP - 20210211
PL  - England
TA  - J Pharm Policy Pract
JT  - Journal of pharmaceutical policy and practice
JID - 101627192
PMC - PMC7877108
OTO - NOTNLM
OT  - Adherence
OT  - Algorithm
OT  - Clostridium difficile infection
OT  - Infectious Diseases Society of America 2010 C. difficile guideline
OT  - Metronidazole
OT  - Vancomycin
COIS- No known competing interest to declare.
EDAT- 2021/02/12 06:00
MHDA- 2021/02/12 06:01
PMCR- 2021/02/11
CRDT- 2021/02/11 05:36
PHST- 2020/08/14 00:00 [received]
PHST- 2020/12/28 00:00 [accepted]
PHST- 2021/02/11 05:36 [entrez]
PHST- 2021/02/12 06:00 [pubmed]
PHST- 2021/02/12 06:01 [medline]
PHST- 2021/02/11 00:00 [pmc-release]
AID - 10.1186/s40545-020-00289-1 [pii]
AID - 289 [pii]
AID - 10.1186/s40545-020-00289-1 [doi]
PST - epublish
SO  - J Pharm Policy Pract. 2021 Feb 11;14(1):19. doi: 10.1186/s40545-020-00289-1.