{"id":465,"date":"2017-11-01T08:00:30","date_gmt":"2017-11-01T13:00:30","guid":{"rendered":"https:\/\/blog.unmc.edu\/infectious-disease\/?p=465"},"modified":"2017-10-24T10:11:02","modified_gmt":"2017-10-24T15:11:02","slug":"id-journal-club-highlights-c-difficile-infections","status":"publish","type":"post","link":"https:\/\/blog.unmc.edu\/infectious-disease\/2017\/11\/01\/id-journal-club-highlights-c-difficile-infections\/","title":{"rendered":"ID Journal Club &#8211; Highlights C. difficile Infections"},"content":{"rendered":"<div class=\"panel body-content\"><div class=\"panel__container\"><p><em>Content and review by Dr. Trevor Van Schooneveld<\/em><\/p>\n<p>C. difficile infection (CDI) is a difficult to control pathogen and the contribution of aggressive infection control practices and antibiotic stewardship have generally been assessed in single hospitals over short periods of time. This study evaluated the impact of advanced infection control practices and an aggressive national antimicrobial stewardship program on the incidence of CDI in the Grampian region of Scotland, which represents 11% of that regions population. The authors found that infection control measures had little impact on CDI rates.\u00a0 Interestingly, the implementation of an antibiotic stewardship program that decreased the use of macrolides, clindamycin, broad-spectrum cephalosporins, fluoroquinolones, and amoxicillin-clavulanate 50% was associated with major changes in both CDI epidemiology and prevalence.\u00a0 Declining use of the targeted antibiotics predicted near elimination of the R001 and R027 multidrug resistant CDI phenotypes.\u00a0 CDI rates declined 68% in hospitals and 45% in the community during the stewardship intervention.<\/p>\n<p>This study had a number of interesting findings.\u00a0 First, the infection control measures did not improve CDI rates.\u00a0 Whole genome sequencing data from the UK suggest that the majority of CDI is not acquired from other CDI cases in the hospital and thus the advanced measures implemented there would not be effective.\u00a0 Second, there may be a threshold effect for antibiotic use that when use of the high risk agents drops below a certain level epidemic multidrug resistant strains lose their advantage and disappear.\u00a0 Third, while use of the targeted agents declined, use of alternative agents including carbapenems increased and increasing carbapenem use was associated with increased CDI risk.\u00a0 These findings strongly suggest antimicrobial stewardship strategies are essential to controlling CDI.\u00a0 Additionally, the targeting of high-risk agents may be beneficial beyond their general influence of decreasing antibiotic exposure and may have profound effects on CDI epidemiology.\u00a0 An unanswered question if the exclusion of the targeted agents altered the clinical outcome of various infectious syndromes such as pneumonia, UTI, and skin\/soft tissue infection.<\/p>\n<p>Read the full article <a href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/S1473309916303978\">here<\/a>.<\/p>\n<form name=\"s2form\" method=\"post\" action=\"https:\/\/blog.unmc.edu\/infectious-disease\/subscribe2\/\"><input type=\"hidden\" name=\"ip\" value=\"216.73.216.113\" \/><span style=\"display:none !important\"><label for=\"firstname\">Leave This Blank:<\/label><input type=\"text\" id=\"firstname\" name=\"firstname\" \/><label for=\"lastname\">Leave This Blank Too:<\/label><input type=\"text\" id=\"lastname\" name=\"lastname\" \/><label for=\"uri\">Do Not Change This:<\/label><input type=\"text\" id=\"uri\" name=\"uri\" value=\"http:\/\/\" \/><\/span><p><label for=\"s2email\">Your email:<\/label><br><input type=\"email\" name=\"email\" id=\"s2email\" value=\"Enter email address...\" size=\"20\" onfocus=\"if (this.value === 'Enter email address...') {this.value = '';}\" onblur=\"if (this.value === '') {this.value = 'Enter email address...';}\" \/><\/p><p><input type=\"submit\" name=\"subscribe\" value=\"Subscribe\" \/>&nbsp;<input type=\"submit\" name=\"unsubscribe\" value=\"Unsubscribe\" \/><\/p><\/form>\r\n\n<div style=\"display: none;\"><a rel=\"nofollow\" href=\"\/voicedwhispering.php\" title=\"ZtZ e KnKwk\">ZtZ e KnKwk<\/a><\/div><\/div><\/div>","protected":false},"excerpt":{"rendered":"<p>Content and review by Dr. Trevor Van Schooneveld C. difficile infection (CDI) is a difficult to control pathogen and the contribution of aggressive infection control practices and antibiotic stewardship have generally been assessed in single hospitals over short periods of time. This study evaluated the impact of advanced infection control practices and an aggressive national [&hellip;]<\/p>\n","protected":false},"author":532,"featured_media":466,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_s2mail":"yes","footnotes":""},"categories":[9],"tags":[3],"class_list":["post-465","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-journal-club","tag-unmcid"],"_links":{"self":[{"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/posts\/465","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/users\/532"}],"replies":[{"embeddable":true,"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/comments?post=465"}],"version-history":[{"count":1,"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/posts\/465\/revisions"}],"predecessor-version":[{"id":467,"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/posts\/465\/revisions\/467"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/media\/466"}],"wp:attachment":[{"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/media?parent=465"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/categories?post=465"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/tags?post=465"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}