Category Archives: Antibitoc Stewardship Guidelines

C. difficile Infection (CDI) Prevention, Treatment, Environmental Safety, Research, Clinical Trials Being Discussed with World Topic Experts On September 20th In Atlanta, Georgia USA


September 20th

It is with great pride and certainty in the power of the healthcare community to present the 4th Annual International Raising. C. diff. Awareness Conference and Health Expo

being hosted at the

DoubleTree by Hilton — Atlanta Airport 
3400 Norman Berry Drive
Atlanta,Georgia 30344 USA  (Hotel Phone: 1-404-763-1600)

Doors open at 7:15 a.m — Sign In and Continental Breakfast

Conference begins at: 7:30 a.m. – 5:00 p.m.


Raising C. difficile awareness is essential to build upon and advance existing knowledge and necessary for overcoming the challenges our healthcare communities are faced with today.

“None of us can do this alone — All of us can do this together”

Nearly half a million Americans suffered from Clostridium difficile (C. diff.) infections in a single year according to a study released February 25, 2015 by the Centers for Disease Control and Prevention (CDC).   C. diff. is a leading cause of infectious disease death worldwide; 29,000 died within 30 days of the initial diagnosis in the USA.   Previous studies indicate that C. diff. has become the most common microbial cause of healthcare-associated infections found in U.S. hospitals driving up costs to $4.8 billion each year in excess health care costs in acute care facilities alone.


Cdiff2015-1Clinical professionals gather for one day to present up-to-date data to expand on the existing knowledge and raise awareness of the urgency focused on a Clostridium difficile infection (CDI) —

    • Prevention
    • Treatments
    • Research
    • Environmental Safety
    • Clinical trials and studies


  • Microbiome research, studies
  • Infection Prevention
  • Fecal Microbiota Restoration and Transplants for Adults & Pediatrics
  • A Panel Of C. diff. Infection Survivors
  • Antibiotic Stewardship
  • Healthcare EXPO
    ……………………and much more.

You won’t want to miss out on this opportunity to learn from
International topic experts delivering data directed at evidence-based
prevention, treatments, and environmental safety in the C. diff.
and healthcare community.

Gain insights on September 20th that will not be available anywhere else with an opportunity to receive up-to-date data on major topics in this program being presented in one day.

5 Leading reasons to attend this dynamic conference:

  • Learn from leading healthcare professionals, clinicians, researchers, and industry.
  • Networking opportunities with new and reconnect with those in the healthcare community with similar interests.
  • Gain breakthrough results through research in progress and gaining positive results. Programs focused on Antibiotic-resistance such as the  Antibiotic Stewardship making a difference. Front line developments in progress focused on C. diff. infection prevention, treatments, environmental safety.
  • Implement and share the knowledge well after the conference ends.  Every attendee receives a booklet with guest speakers information, media to review audio programs, and Health Expo Sponsor information focused on the important agenda topics.
  • Embrace the opportunity, with all of the topic experts presenting, and hold the conference in the highest priority from the participation in this conference to an audience of medical students, and fellow healthcare professionals, who will benefit the most from the data and gain tools to overcome the barriers facing healthcare each day.

“The information and up-to-date studies shared at the 2015 conference added to an existing knowledge base that helps us to continue delivering quality care in the medical community.”   Linda Davis, RN,BSN



$75.00  —  Conference Registration

$30.00  —  Student Conference Registration (Student ID To Be Presented At the Door)

TO REGISTER Click on the “Raising C. diff. Awareness” Ribbon below


Room accommodations are available —  Complete and Confirm 

by August 19th to reserve your hotel reservations.   

To create a reservation please click on the DoubleTree By Hilton Logo below – – – – – –



 A suggested travel coordinator, for your convenience

LibertyTraveldownloadMichael Beckman — Team Leader,  Liberty Travel, 467 Washington Street, Boston, MA  02111

 For Additional Information visit the C Diff Foundation Website:

And Click on the 2016 September Conference Tab


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C Diff Foundation Welcomes Barley Chironda, RPN, CIC


We are pleased to welcome Barley Chironda, RPN, CIC  to the C Diff Foundation in the role of Infection Prevention Advocate.

Barley Chironda, RPN, CIC is a Nurse and is the Social Media Manager of IPAC Canada and the current President of IPAC- GTA.

He is also the National Healthcare Sales Director and Infection Control Specialist with Clorox Canada. Mr. Chironda is certified in Infection prevention and control (CIC™) and has worked extensively in Infection Control.  He is typically found engaged in motivating hospital staff, patients and the public on proper infection prevention practices.

Mr. Chironda’s roles allow great participation in quality improvement interventions related to patient and public safety. Therefore Barley has been an integral to the successful decline in Clostridium difficile infections through implementing innovative technology and quality improvement behavioral change.

Barley takes great pride in sharing information via social media and is often engaging the public on Twitter™ and LinkedIn™, partaking in resource distribution related to innovative and novel Infection prevention strategies.


U.S. Food and Drug Administration Advises Serious Side Effects Associated With Fluoroquinolone Antibacterial Medication


The Division of Drug Information (DDI)- serving the public by providing information on human drug products and drug product regulation by FDA.

The U.S. Food and Drug Administration is advising that the serious side effects associated with fluoroquinolone antibacterial drugs generally outweigh the benefits for patients with sinusitis, bronchitis, and uncomplicated urinary tract infections who have other treatment options.  For patients with these conditions, fluoroquinolone should be reserved for those who do not have alternative treatment options. 

The new FDA ruling calling for restricted use of fluoroquinolones affects five prescription antibiotics: ciprofloxacin (Cipro), levofloxacin (Levaquin), moxifloxacin (Avelox), ofloxacin (Floxin), and gemifloxacin (Factive). All are also available as generics.




For Additional Information Regarding This Topic – Please Visit The Following Consumer Article:

An FDA safety review has shown that fluoroquinolones when used systemically (i.e. tablets, capsules, and injectable) are associated with disabling and potentially permanent serious side effects that can occur together.  These side effects can involve the tendons, muscles, joints, nerves, and central nervous system. 

As a result, we are requiring the drug labels and Medication Guides for all fluoroquinolone antibacterial drugs to be updated to reflect this new safety information.  We are continuing to investigate safety issues with fluoroquinolones and will update the public with additional information if it becomes available.

Patients should contact your health care professional immediately if you experience any serious side effects while taking your fluoroquinolone medicine.   Some signs and symptoms of serious side effects include tendon, joint and muscle pain, a “pins and needles” tingling or pricking sensation, confusion, and hallucinations.  Patients should talk with your health care professional if you have any questions or concerns.

Health care professionals should stop systemic fluoroquinolone treatment immediately if a patient reports serious side effects, and switch to a non-fluoroquinolone antibacterial drug to complete the patient’s treatment course.  

Fluoroquinolone drugs work by killing or stopping the growth of bacteria that can cause illness.

We previously communicated safety information associated with systemic fluoroquinolone antibacterial drugs in August 2013 and July 2008.  The safety issues described in this Drug Safety Communication were also discussed at an FDA Advisory Committee meeting in November 2015. 

We urge patients and health care professionals to report side effects involving fluoroquinolone antibacterial drugs and other drugs to the FDA MedWatch program, using the information in the “Contact FDA” box at the bottom of the page.

For more information, please visit: Fluoroquinolone.


Antibiotic Stewardship Program and Updates From Sources: CDC, Pew Charitable Trusts, With IDSA and SHEA Guidelines

Antibiotic Stewardship Information and Update:

Inpatient antibiotic stewardship programs (ASPs) lower rates of healthcare-associated infections, increase microbial susceptibility to antibiotics, and save healthcare costs, according to ten case studies published in an Apr 26 report from the Pew Charitable Trusts (PCT).

“All antibiotic use contributes to the proliferation of antibiotic-resistant bacteria, and more than 2 million people are infected with antibiotic-resistant organisms each year in the United States, resulting in more than 23,000 deaths,” the 63-page report says. The US Centers for Disease Control and Prevention (CDC) released a report in 2013 estimating that about half of antibiotics prescribed each year are unnecessary.

To listen to the February 2016 Podcast: Using Antibiotics Wisely, How You Can Help In the Fight Against Antibiotic Resistance — with Doctors Laurie Hicks and Arjun Srinivansan from the CDC — click on the link below:

ASPs curb inappropriate antibiotic prescriptions with clinician education, better matching of antibiotics to infections (bug-drug matches), and rigorous authorization protocols for prescriptions, yet often are met with some resistance due to funding insufficiency, lack of dedicated staff or laboratory capability, and changes in accepted standards of care.

PCT’s report, “A Path to Better Antibiotic Stewardship in Inpatient Settings,” describes ASPs in five community hospitals, three academic hospitals, and two long-term care facilities. Each had incorporated all seven of the CDC’s “Core Elements of Hospital Antibiotic Stewardship”: leadership commitment, accountability, drug expertise, action (eg, systems to monitor treatment and bug-drug matches), education, tracking, and reporting.

To review the updated IDSA and SHEA “Antibiotic Stewardship” Guidelines please click on the link below:


All except an academic hospital with a 20-year history of antibiotic stewardship interventions implemented their programs between 2006 and 2011. Though all demonstrated significant leadership and commitment to the interventions, each facility used practices and technology specific to their patient populations, outbreak history, staff availability, and lab capacity.

Administrative and physician support for stewardship

Outbreaks and high rates of healthcare-associated infections spurred operational support and funding for ASPs in four facilities, according to the report. Vibra Hospital of Northern California in Redding, Calif., and Sharp Villa Coronado Long-Term Care Facility in Coronado, Calif., were able to obtain support for nascent ASPs after linking antibiotic use to increases in healthcare-associated Clostridium difficile (C diff) infections.

Park Manor Nursing Home in Park Falls, Wis., and St. Tammany Parish Hospital in Covington, La., instituted their protocols after an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) and an increase in infections after coronary artery bypass grafts, respectively.

Blessing Hospital in Quincy, Ill., received institutional approval for an ASP after demonstrating the need for stewardship with a 4-month study on inappropriate use of aztreonam, tigecycline, daptomycin, and linezolid.

Staff roles and laboratory capacity

Most ASPs were led by at least one infectious disease or family practice physician and pharmacist who dedicated several hours per week to monitoring prescriptions and effectiveness of antibiotic treatment, the report explains. Exceptions were the program at Sharp Villa Coronado Long-Term Care Facility, which was led by pharmacists and pharmacy students, and the nurse-led ASP at Park Manor Nursing Home.

Because Park Manor had neither an on-site physician nor a pharmacist, nurses maintained detailed reports of patient infections, bacterial culture results, and antibiotic use, and then developed scripts to communicate patient status and care to physicians. The use of nursing staff to shepherd stewardship efforts, carry out active surveillance for urinary and respiratory tract infections, and communicate between patients and doctors reduced the number of unnecessary prescriptions, the authors said.

Both long-term care facilities were able to perform simple lab tests but had to send samples off-site for more complex testing and culturing. Several community hospitals lacked the ability to conduct on-site and/or rapid diagnostic testing and culturing, which increased waiting time for decisions about antibiotic therapy.

Lowering antibiotic use and infections

Ongoing treatment monitoring and patient interventions had the most measurable effects on inappropriate antibiotic use, the report states. Vibra Hospital found that changes to antibiotic regimens were needed in all 93 patient cases it monitored from May to June 2015. Vibra clinicians worked with the ASP to schedule antibiotic treatment stop dates for 46 patients, discontinue treatment for 42, review cultures and assign new prescriptions in 10 cases, and change four dosages because of new information on weight or kidney function.

Sharp Villa’s implementation of an antibiotic dosing protocol to prevent renal toxicity and ongoing therapy assessment lowered antibiotic use by 59%, with significant decreases in broad-spectrum antibiotics, vancomycin, antifungals, and C diff therapies. From 2011 to 2015, Escherichia coli susceptibility to levofloxacin at Sharp Villa rose from 24% to 54%.

Several facilities saw decreases in healthcare-associated C diff rates after ASP implementation. After educating physicians on substitutes for restricted or nonformulary antibiotics and transitions from intravenous to oral therapy, Williamson Medical Center in Franklin, Tenn., observed C diff rates fall from 26.3 infections per 10,000 patient-days in 2013 to 21.1 cases per 10,000 patient-days in 2014. At the same facility, the susceptibility of Pseudomonas aeruginosa to levofloxacin increased from 58% in 2009 to 79% in 2014.

St. Tammany’s antibiotic treatment surveillance and training interventions led to a fall in C diff rates from 9.6 per 10,000 patient-days in 2013 to 6.4 in 2014. Through active surveillance and close physician-pharmacist partnerships, the hospital was also able to reduce daily doses of daptomycin by 84%, linezolid by 79%  tigecycline by 86%, and micafungin by 61%, and lowered total antimicrobial costs from $25.93 to $8.32 per patient-day.

The University of California, Davis Medical Center’s focus on prescription audits, bug-drug mismatches confirmed by culture, yeast colonization of sterile sites, and vancomycin resistance yielded a 23% reduction in C diff rates, which saved an estimated $23,540 in costs. Prescription decreases for 11 antibiotics targeted for intervention by the facility’s ASP led to cost savings of about $119,009 since the program began in 2011.

Opportunities and challenges

In most cases, ASPs at the 10 facilities proved effective when procedures were automated and when continual communication about antibiotic therapy was maintained between clinicians, pharmacists, and lab staff, according to the report. For example, Strong Memorial Hospital in Rochester, N.Y., held weekly antibiotic stewardship rounds between ASP members and six clinical services. Three hospitals observed increasing clinician acceptance of pharmacists’ prescribing recommendations over the course of their programs.

Barriers noted by some of the hospitals and centers included lack of dedicated staff time and funding for technology, including electronic health records in long-term care centers, that would more closely track patient therapies.

A recent action plan from the Obama administration proposed that all acute care hospitals and long-term care facilities implement ASPs, and California recently made it a requirement for acute care hospitals. Given the trend toward formalizing antibiotic stewardship and the benefits such programs can yield for patient care, microbial susceptibility, and facility costs, these case studies offer diverse methods and results to help burgeoning programs evaluate ASP feasibility in their institutions, the report says.

To read article in its entirety – click on the link below:

IDSA and SHEA Release New Antibiotic Stewardship Guidelines

In The News

April 2016

Preauthorization of broad-spectrum antibiotics and prospective review after two or three days of treatment should form the cornerstone of antibiotic stewardship programs to ensure the right drug is prescribed at the right time for the right diagnosis. These are among the numerous recommendations included in new guidelines released by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) and published in the journal Clinical Infectious Diseases.

“Initially, antibiotic stewardship was more focused on cost savings, and physicians responded negatively to that, because they often felt it was best to give patients the newest, most expensive drug,” said Tamar Barlam, MD, lead co-author of the guidelines, director of the antibiotic stewardship program at Boston Medical Center and associate professor of medicine at Boston University Medical School. “While these programs do save hospitals money, their most important benefit is that they improve patient outcomes and reduce the emergence of antibiotic resistance. When we say stewardship, we really mean stewardship, and increasingly, doctors are realizing it’s important and necessary.”

The White House has called for hospitals and healthcare systems to implement antibiotic stewardship programs by 2020 to ensure appropriate use of these vital drugs and reduce resistance, an escalating problem that threatens the ability to effectively treat often life-threatening infections.

The new guidelines replace those originally created to help with the development of programs when antibiotic stewardship was in its infancy, and instead focus on specific strategies that the evidence suggests are most beneficial to ensure the program will be effective and sustainable. They also note it is key that these programs tailor interventions based on local issues, resources and expertise. To ensure that, the guidelines recommend the programs be led by physicians and pharmacists and rely on the expertise of infectious diseases specialists.

“We want hospital administrators to understand the importance of giving antibiotic stewardship their full support to ensure its success,” said Sara Cosgrove, MD, MS, lead co-author of the guidelines, president-elect of SHEA and associate professor of medicine and epidemiology at Johns Hopkins University, and director of the antimicrobial stewardship program and associate hospital epidemiologist at The Johns Hopkins Hospital, Baltimore. “Distributing a few brochures or holding grand rounds won’t do it. It’s vital that antibiotic stewardship be integrated into the hospital’s culture and that infectious disease specialists guide strategies that have been shown to work.”

The guidelines note that more research needs to be done to determine how to ensure antibiotic stewardship is most effective. However, the best evidence to date suggests a number of components, including the following, will help ensure the implementation of an effective antibiotic stewardship program.

  • Preauthorization or prospective audit and feedback – Targeted antibiotics, such as those that treat emerging drug-resistant bacterial infections, should require preauthorization. This means providers need to get approval to use antibiotics before they are prescribed. Prospective audit and feedback can be an alternate strategy or combined with preauthorization. Prospective audit allows antibiotic stewards to engage the prescribing clinician after the antibiotic has been used, typically after two or three days, to optimize antibiotic treatments. Both methods can reduce antibiotic misuse and decrease the development of resistance. Hospitals should choose one or both of these methods as part of their program based on their local resources and expertise.
  • Syndrome-specific interventions – The guidelines recommend focused multifaceted interventions for the treatment of specific syndromes, rather than trying to improve treatment of all infections at once. For example, Dr. Barlam said those leading a hospital’s antibiotic stewardship program might take a close look at management of pneumonia during winter, including making recommendations to shorten the amount of time people are treated and switching to an oral agent more quickly, and then measuring the results of those interventions. In the fall, the program might focus on urinary tract infections and then several months later, switch to skin and soft tissue infections. “This method makes stewardship more manageable and provides a targeted and clear treatment message rather than trying to disseminate 100 different lessons at the same time,” she said.
  • Rapid diagnostic testing – The guidelines note that rapid diagnostic testing of respiratory specimens can help determine if the cause is viral and therefore reduce the inappropriate use of antibiotics. They also note that the rapid testing of blood cultures in addition to conventional culture is helpful, but should be guided by the antibiotic stewardship team for maximum benefit to the patient.

Other recommendations include reducing the use of antibiotics associated with Clostridium difficile infection, implementing antibiotic time-outs and other strategies to encourage prescribers to perform routine reviews of regimens and using computerized clinical decision support if possible.

The guidelines do not recommend relying solely on passive educational materials to implement antibiotic stewardship because any improvement likely will not be sustained. Lectures and brochures should be used to supplement strategies such as antibiotic preauthorization and prospective audit and feedback, the authors note.


  • Preauthorization and prospective review of antibiotics are among the many recommendations to ensure antibiotic stewardship programs are most effective, suggest new guidelines from IDSA/SHEA.
  • Antibiotic stewardship programs should be led by physicians and pharmacists, including ID specialists, who have the expertise and education to ensure the right drug is being prescribed at the right time for the right diagnosis.
  • Antibiotic stewardship programs must be based on the specific problems identified by the healthcare facility and a realistic examination of available resources to ensure interventions are performed with consistency.
  • These programs have been shown to improve patient outcomes, reduce antibiotic resistance and save money.

In addition to Drs. Barlam and Cosgrove, the antibiotic stewardship program guidelines panel includes: Lilian Abbo, Conan MacDougall, Audrey N. Schuetz, Ed Septimus, Arjun Srinivasan, Timothy Dellit, Yngve T. Falck-Ytter, Neil Fishman, Cindy W. Hamilton, Timothy C. Jenkins, Pamela A. Lipsett, Preeti N. Malani, Larissa S. May, Gregory J. Moran, Melinda M. Neuhauser, Jason Newland, Christopher A. Ohl, Matthew Samore, Susan Seo and Kavita K. Trivedi.

IDSA and SHEA individually have published myriad treatment guidelines and together have published several, including the prevention of healthcare-associated infections and antimicrobial prophylaxis in surgery.

As with other IDSA and SHEA guidelines, the antibiotic stewardship guidelines will be available in a smartphone format and a pocket-sized quick-reference edition.

The full guidelines are available free on the

IDSA website at


SHEA website at


To read this article in its entirety click  on the following link: