The burden of healthcare associated Clostridium difficile infection in a non-metropolitan setting

Bond, S.E. et al. The Journal of Hospital Infections. Published online: December 18 2016

Objective: Healthcare-associated Clostridium difficile infection (HCA-CDI) remains a major cause of morbidity and mortality in industrialised countries. However, few data exist on the burden of HCA-CDI in multisite non-metropolitan settings. This study examined the introduction of an antimicrobial stewardship program (ASP) in relation to HCA-CDI rates and the effect of HCA-CDI on length of stay (LOS) and hospital costs.

 

Conclusions: HCA-CDI placed a significant burden on our regional and rural health service through increased LOS and hospital costs. Interventions targeting HCA-CDI could be employed to consolidate the effects of ASPs.

Read the full abstract here

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Antibiotic use in the acute setting

Fawcett, N. et al. Antibiotic use and clinical outcomes in the acute setting under management by an infectious diseases acute physician versus other clinical teams: a cohort study. BMJ Open Volume 6 Issue 8

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Abstract

Objectives To assess the magnitude of difference in antibiotic use between clinical teams in the acute setting and assess evidence for any adverse consequences to patient safety or healthcare delivery.

Design Prospective cohort study (1 week) and analysis of linked electronic health records (3 years).

Setting UK tertiary care centre.

Participants All patients admitted sequentially to the acute medical service under an infectious diseases acute physician (IDP) and other medical teams during 1 week in 2013 (n=297), and 3 years 2012–2014 (n=47 585).

Primary outcome measure Antibiotic use in days of therapy (DOT): raw group metrics and regression analysis adjusted for case mix.

Secondary outcome measures 30-day all-cause mortality, treatment failure and length of stay.

Results Antibiotic use was 173 vs 282 DOT/100 admissions in the IDP versus non-IDP group. Using case mix-adjusted zero-inflated Poisson regression, IDP patients were significantly less likely to receive an antibiotic (adjusted OR=0.25 (95% CI 0.07 to 0.84), p=0.03) and received shorter courses (adjusted rate ratio (RR)=0.71 (95% CI 0.54 to 0.93), p=0.01). Clinically stable IDP patients of uncertain diagnosis were more likely to have antibiotics held (87% vs 55%; p=0.02). There was no significant difference in treatment failure or mortality (adjusted p>0.5; also in the 3-year data set), but IDP patients were more likely to be admitted overnight (adjusted OR=3.53 (95% CI 1.24 to 10.03), p=0.03) and have longer length of stay (adjusted RR=1.19 (95% CI 1.05 to 1.36), p=0.007).

Conclusions The IDP-led group used 30% less antibiotic therapy with no adverse clinical outcome, suggesting antibiotic use can be reduced safely in the acute setting. This may be achieved in part by holding antibiotics and admitting the patient for observation rather than prescribing, which has implications for costs and hospital occupancy. More information is needed to indicate whether any such longer admission will increase or decrease risk of antibiotic-resistant infections.

Infection prevention and control: lessons from acute care in England

Latest Health News

November 2015 | The Health Foundation

Infection control has been high on the political agenda and on the agenda of the NHS in England in recent years. There have been many successes, not least the reduction in MRSA bloodstream infections and cases of Clostridium difficile infection. However, other health care associated infections that have not been monitored as rigorously are growing in incidence. New infections, including the growing number of more resistant strains of bacteria, are in danger of spreading. As a result, infection control needs to remain central to the work of the NHS.

This learning report is based on the findings of a large research study that identified and consolidated published evidence about infection prevention and control initiatives. The researchers synthesised this with findings from qualitative case studies in two large NHS hospitals, including the perspectives of service users.

via Infection prevention and control: lessons from acute care in England | The…

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