Tag Archives: Dr Arjun Srinivasan MD

Highlights Of the Latest Advances In the Battle Against the Deadly Pathogen – Dale Gerding, MD

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TO READ THIS ARTICLE IN ITS ENTIRETY AS PUBLISHED IN THE MD MAGAZINE — PLEASE CLICK ON THE FOLLOWING LINK TO BE REDIRECTED:

 

http://www.mdmag.com/medical-news/c-diff-foundation-highlights-latest-advances-in-the-battle-against-the-deadly-pathogen

In September, researchers, health care workers, and industry and patient advocates convened for the 4th Annual International Raising C. diff Awareness Conference and Health Expo in Atlanta.

Clifford McDonald, MD, Associate Director for Science in the Division of Healthcare Quality Promotion at the Centers for Disease Control and Prevention (CDC), chaired the conference. In his role at the CDC, McDonald’s at the forefront of efforts to prevent and treat the infection – one the CDC has declared among the most urgent drug-resistant threats that we currently face.

“It’s my firm belief that we are on the threshold of a new era in better diagnosis, treatment, and prevention approaches. At the CDC, we deal with statistics, but there are faces behind those numbers. At the heart of every infection is a patient who deserves our competence, our empathy, and our passion,” said McDonald.

One of those faces, Roy Poole, is a volunteer patient advocate for the  C Diff Foundation. After retiring from a career in the Air Force, Poole led a healthy, active lifestyle as an avid outdoors-man in Colorado before antibiotics prescribed for a routine dental procedure set the stage for CDI. In the medical community, his symptoms were met with disbelief and inappropriate treatment.

“Three weeks after leaving the hospital, I walked into my (previous) primary care physician, and asked for an order to have a stool sample taken to determine if Toxins A or B were present. His response was, ‘Are you still having problems with that?’ Clearly, there is a need for more education about C. diff among physicians,” said Poole.

CDI is a formidable opponent. However, with the newly focused attention on discovering ways to disable the bacteria and cohesive public health approaches aimed at prevention, presenters from government, academia and industry offered five key reasons we can win the battle against C. diff:

Antibiotic stewardship efforts are gaining a foothold.
Statistics present a chilling picture: 453,000 new cases and an estimated 30,000 deaths each year. It’s likely that those numbers grossly underestimate the true impact of CDI, since it’s what we know from death certificate reporting.

However, we are seeing that rates may have peaked after a long plateau. Mark Wilcox, MD, Head of Microbiology at Leeds Teaching Hospital, Professor of Medical Microbiology at University of Leeds, and the lead on Clostridium difficile for Public Health England in the United Kingdom, has demonstrated a 70% reduction in cases in England in just 7 years. This was after a concerted effort that Wilcox spearheaded surrounding antibiotic stewardship, specifically addressing a reduction in unnecessary prescribing of fluoroquinolones and cephalosporin antibiotics.

Commonly prescribed antibiotics disrupt the protective microbiota (the normal bacteria of the gut) and leave it vulnerable for C. diff colonization. “There was a concerted effort that went beyond lip service and truly embraced the principles of improved surveillance, more accurate diagnostics, enhanced infection prevention measures to use antibiotics more wisely and to limit transmission and careful treatment,” said Wilcox.

High rates of CDI are always associated with the use of certain antibiotics: clindamycin, cephalosporin, and fluoroquinolones. Research has shown that lower respiratory tract infections and urinary tract infections account for more than 50% of all in-patient antibiotics use. But are these really necessary?

“We know that antibiotics are overused and misused across every healthcare setting. At least 30% of antibiotic prescriptions are unnecessary – and this equates to 47 million unnecessary antibiotic prescriptions per year written in doctors’ offices, hospital outpatient departments, and emergency departments. We have a lot of work to do, and CDC is actively working to reduce unnecessary antibiotic use,” said Arjun Srinivasan, MD at the CDC. “Stopping unnecessary antibiotics is the single most effective thing we can do to curb C. diff infections in the United States. This is something that we can do today.”

Srinivasan acknowledged that telling patients that they can’t have a prescription for an antibiotic might result in some pushback. “Patient satisfaction scores are a very real concern. When someone is sick and takes a day off work, they’re not leaving without a prescription – especially when the last provider wrote one for their same symptoms,” he said. “But this is a new day, and it’s up to the physician to educate their patients and stay strong.”

Hospitalists have access to accurate, inexpensive and quick diagnostic tests that can lead to targeted, effective treatment. This can arm the treating physician and patient with information that can put patients on a path to recovery without feeling like they are being dismissed.

Emerging guidance reflects important advances in research and development.

Most recently published in 2010, the Society for Healthcare Epidemiology of America (SHEA) and Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for C. diff are currently under review. This is critical because of the number of physicians still treating with metronidazole first, despite the fact that the largest randomized controlled clinical trial has shown that vancomycin is more effective.

“Since 2010, the landscape has changed dramatically,” said Stuart B. Johnson, MD, Professor, Department of Medicine, Loyola University, and Researcher at the Hines VA Hospital in Chicago.

“The past few years have ushered in a new age of understanding how and where C. diff colonizes, and the damaging toxins A and B that it produces.”

Considering that 25-30% of patients experience a CDI recurrence, it’s evident that metronidazole unnecessarily contributes to the failed treatment outcomes for patients. Metronidazole is less expensive, but has more side effects than oral vancomycin and is less effective in treating CDI.

Johnson provided an overview of the dramatic advances this space has seen in just the past few years.

Limitations of current guidelines include:
•       No mention of fidaxomicin, a narrow-spectrum antibiotic, which in 2011 was the first medication approved in 25 years for the treatment of C. diff associated diarrhea
•       Limited evidence for recommendations to treat severe, complicated CDI
•       Limited evidence for recommendations on recurrent CDI
•       Little mention of Fecal Microbiota Transplant (FMT)

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5.  Patient advocacy and awareness efforts can alter the course of CDI.
CDI survivors shared their experiences along their emotional journey – fear, disbelief, isolation, and depression. They also expressed gratitude at the validation, information and support they received from the patient advocacy community. Perhaps the greatest gift they have received is the empowerment to question their physicians about the necessity of antibiotics they have been prescribed in terms of risk of CDI.

“The hospital where I was treated initially seemed eager to have me leave. They offered no additional help. The C diff Foundation has been my greatest source of help. In turn, I feel I help myself cope best, when I help others to cope with the disease,” said Poole.

TO READ THIS ARTICLE IN ITS ENTIRETY AS PUBLISHED IN THE MD MAGAZINE 

PLEASE CLICK ON THE FOLLOWING LINK TO BE REDIRECTED —- THANK YOU

http://www.mdmag.com/medical-news/c-diff-foundation-highlights-latest-advances-in-the-battle-against-the-deadly-pathogen

 

Dale Gerding, MD, FACP, FIDSA, is Professor of Medicine at Loyola University Chicago, Research Physician at the Edward Hines Jr. VA Hospital. Additionally, Gerding is an infectious disease specialist and hospital epidemiologist, past president of the Society for Healthcare Epidemiology of America and past chair of the antibiotic resistance committee of SHEA. He is a fellow of the Infectious Diseases Society of America and past chair of the National and Global Public Health Committee and the Antibiotic Resistance Subcommittee of IDSA. His research interests include the epidemiology and prevention of Clostridium difficile, antimicrobial resistance, and antimicrobial distribution and kinetics.

The paper, “Burden of Clostridium difficile Infection in the United States,” was published in the New England Journal of Medicine.

The study, “Changing epidemiology of Clostridium difficile infection following the intriduction of a national ribotyping-based surveillance scheme in England,” was published in the journal Clinical Infectious Diseases.

The study, “Prevalence of antimicrobial use in US acute care hospitals,” was published in JAMA.

The paper, “Vancomycin, metronidazole, or toleyamer for Clostridium difficile infection: results from two multinaionalm randomized, controlled trials,” was published in Clinical Infectious Diseases.

The study, “A Randomized Placebo-controlled Trial of Saccharomyces boulardii in Combination with Standard Antibiotics for Clostridium difficile disease,” was published in JAMA.

Global C. difficile Congress – Eight Sessions In Four Hours Webinar – A Half Day To Change the C. difficile World

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Raising global awareness with leading international topic experts have proven to be effective over the years with audiences attending our annual conferences.

 

The Global C. difficile Congress took place on November 11th, 2016 and broadened existing knowledge surrounding C. difficile infection (CDI)  prevention, treatments, research, and environmental safety worldwide.

The drive and passion takes us forward in promoting the practical and technical advancements taking place across the globe.  Healthcare Professionals from every area of expertise, discussed the control and  treatment options,  the healthcare perspectives, antibiotic-resistance stewardship programs, and much more to raise C. diff. awareness and share successful implementations and guidelines.

This free webinar is available to you and with the ease of learning without having to travel.

The Global C. difficile Congress  —  eight sessions presented by topic experts  – in four hours – in one day –  with goals to change the C. difficile world with a common focus; To
improve awareness of C. diff. infection prevention, treatments, research, and environmental safety in the healthcare communities worldwide.

 

https://recordings.join.me/ezyFo7graka6cXR8nmjkoQ

 

Guest Speakers and Program Topics

USA    ET                         UK TIME               GUEST SPEAKER

8:00 – 8:15 a.m.            1:00 – 1:15 p.m.       Paul Feuerstadt, MD

Dr. Paul Feuerstadt; Native of Long Island, New York, Dr. Feuerstadt attended the University of Pennsylvania where he earned his Bachelor of Arts degree in Biology, with distinction in research and graduated Summa Cum Laude. Following completion of his undergraduate training, Dr. Feuerstadt attended the Weill Medical College of Cornell University in Manhattan, New York where he earned his Medical Doctor degree and stayed at New York Presbyterian Hospital/Weill Cornell medical center for his internship and residency in Internal Medicine. Following completion of his residency
Dr. Feuerstadt then moved on to the Montefiore Medical Center in the Bronx, NY for his clinical fellowship training.His areas of interest include ischemic diseases of the gut and chronic diarrheal syndromes with a specific focus on C.diff. infections.Dr. Feuerstadt is affiliated with St. Raphael campus of Yale-New Haven Hospital, Yale-New Haven Hospital and
Milford Hospital seeing outpatients in his offices in Hamden and Milford, CT
Topic: Welcome – Introduction

8:15 – 8:45 a.m.            1:15 – 1:45               Jean de Gunzburg, PhD

Dr. de Gunzburg is Chief Scientific Officer of Da Volterra, an emerging biotechnology company, headquartered in Paris, France.  Prior to this, Jean de Gunzburg led an academic research career in molecular and cell biology at the Institut Pasteur (Paris, France), the Whitehead Institute for Biomedical Research (Cambridge, MA, USA) and the Institut Curie (Paris, France). He is the author of over 70 publications in international peer reviewed scientific journals, and continues to serve on several grant review committees.
Topic: “DAV132, A  Novel Product Destined To Prevent Antibiotic-Induced
Clostridium difficile Infections.”

8:45 – 9:15                   1:45 – 2:15                Arjun Srinivasan, MD

Dr. Arjun Srinivasan is the Associate Director for healthcare-associated infection (HAI) prevention programs in the Division of Healthcare Quality Promotion at the Center for Disease Control and Prevention’s National Center for Emerging and Zoonotic Infectious Diseases. Dr. Srinivasan is also a captain in the US Public Health Service. An infectious disease doctor, Dr. Srinivasan oversees several CDC programs aimed at eliminating healthcare-associated infections and improving antibiotic use. For much of his CDC career, Dr. Srinivasan ran the healthcare outbreak investigation unit, helping hospitals and other healthcare facilities track down bacteria and stop them from infecting other patients. Dr. Srinivasan leads the CDC’s work to improve antibiotic prescribing and works with a team of CDC experts researching new strategies.
Topic: Antibiotic Stewardship- Improving Antibiotic Use to Combat C diff.”

9:15 – 9:45                   2:15 – 2:45               Clifford McDonald, MD

Dr. McDonald graduated from Northwestern University Medical School. He completed a medical microbiology fellowship at Duke University and is a former member of CDC’s Epidemic Intelligence Service. Dr. McDonald is currently the Associate Director for Science in the Division of Healthcare Quality Promotion at the CDC. He has first authored or co-authored over 100 peer reviewed publications on subjects related to healthcare and infectious disease epidemiology Dr. McDonald joins fellow world-renowned topic experts to discuss the burden of C. difficile infections with the risk factors pertaining to current and emerging treatment options along with the importance of applying evidence-based clinical approaches to the prevention of  a C. difficile infection (CDI), one of the leading community and healthcare-associated infections.
Topic: “Challenges and Opportunities Posed by Current Diagnostics
for Clostridium difficile Infection”

9:45 – 10:15                 2:45 – 3:15               Barley Chironda,, RPN, CIC

Barley Chironda a Nurse, National Healthcare Sales Director and Infection Control Specialist Clorox Canada, Social Media Manager of IPAC Canada,  and the current President of IPAC- GTA.    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.
Topic:  “The C.diff.. Disinfection Debate: To Use
Or Not To Use Sporicidal Disinfectants Every-Time In Healthcare Facilities.”

10:15 -10:45                 3:15 – 3:45              Dale Gerding, MD

Dr. Dale Gerding,  Professor of Medicine at Loyola University Chicago Stritch School of Medicine in Maywod, Illinois and Research Physician at the Edward Hines Jr. VA Hospital. Prior to his present position Dr. Gerding was Chief of Medicine at VA Chicago, Lakeside Division, and Professor of Medicine at Northwestern University Feinberg School of Medicine.  He is an infectious diseases specialist and hospital epidemiologist, past president of the Society for Healthcare Epidemiology of America and past chair the antibiotic resistance committee of SHEA.  He is a fellow of the Infectious Diseases Society of America and past Chair of the National and Global Public Health Committee and the Antibiotic Resistance Subcommittee of IDSA. He served as a member of the Board of Directors of IDSA from 2005-2008. He is a Master of the American College of Physicians and the 2013 recipient of the William Middleton Award, the highest research award given by the Department of Veterans Affairs. He is a member of the American Society for Microbiology, and is board certified in Internal Medicine and Infectious Diseases. His research interests include the epidemiology and prevention of  Clostridium difficile disease, antimicrobial resistance, and antimicrobial distribution and kinetics.  He has been a Merit Review funded research investigator in the VA for over 40 years and is the author of over 400 peer-reviewed journal publications, book chapters, and review articles.  He holds patents for the use of non-toxigenic C. difficile for the prevention and treatment of this disease.
Topic: “Non-toxigenic Clostridium difficile for Prevention of CDI”

10:45 – 11:15               3:45 – 4:15               Richard Vickers, PhD

Dr. Richard Vickers is the Chief Scientific Officer, Antimicrobials and Programme Lead for CDI,
Summit Therapeutics.  He joined Summit in 2003 and during his time has worked in a variety of roles involved in the development and management of various antibacterial therapeutic programs.  This includes leading the discovery and development of ridinilazole, the investigational antibiotic for the treatment of C. difficile infection. Prior to joining Summit, Dr Vickers undertook postdoctoral research studies with Professor Stephen Davies at the University of Oxford and held a Stipendiary Lectureship in organic chemistry at St. Catherine’s College in Oxford. Dr Vickers received a Ph.D. in organic chemistry from the University of Reading and a B.Sc. in chemistry from King’s College London.
Topic: “Ridinilazole; A Selective Therapy for the Treatment
of C. difficile Infections (CDI)”

11:15 – 11:45               4:15 – 4:45               Simon Cutting, PhD

Professor Cutting of Molecular Microbiology at Royal Holloway, University of London is a bacterial geneticist with over 25 years of experience with Bacillus since graduating from Oxford University with a D. Phil in 1986. His D.Phil was on understanding the genetic control of spore formation in Bacillus Clostridium difficile.. His other expertise is in the use of Bacillus spores as probiotics and has a number of contracts and consultancies with European and US companies in the food and feed sectors.
Topic: “Thwarting the Opportunist: An Anti-adhesion
Vaccine That Prevents C.difficult Colonization.”

11:45 – 12:15               4:45 – 5:15               Hudson Garrett, Jr, PhD

Dr. Garrett is currently employed as the Global Chief Clinical Officer for Pentax Medical. He holds a dual Masters in Nursing and Public Health, Post-Masters Certificate as a Family Nurse Practitioner, a Post-Masters Certificate in Infection Prevention and Infection Control and a PhD in Healthcare Administration and Policy. He has completed the Johns Hopkins Fellows Program in Hospital Epidemiology and Infection Control, and the CDC Fundamentals of Healthcare Epidemiology program, and is board certified in family practice, critical care, vascular access, moderate sedation, infection prevention, legal nurse consulting, and a director of nursing in long term care.  Dr. Garrett is also a Fellow in the Academy of National Associations of Directors of Nursing Administration in Long Term Care.
Topic:  “Improving Patient Safety and Reducing Clostridium difficile
through Collaboration with Clinical Nursing and Environmental Services Professionals”

 

For more information please visit the Global C. difficile Congress

http://www.globalcdifficilecongress.org

 

Thanks and Appreciation To Our Guests For Joining Us On C. diff. Spores And More Season II

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As Season II concludes, we wish to take this opportunity to sincerely thank each
and every guest for taking time out of their
busy schedule and joining us on Tuesday’s at
10:00a Pacific Time / 1:00p Eastern Time over the past seven months.

C. diff. Spores and More Global Broadcasting Network will be taking a break and will return to live broadcasting on  January 17th, 2017 with the Centers for Disease Control and Prevention (CDC) leading the way with our guest
Dr. Katherine Fleming-Dutra, Medical Officer, CDC’s Office of Antibiotic Stewardship.

A Prescription for Over-Prescribing: The Key to Fighting
Antibiotic Resistance

Dr. Fleming-Dutra is a medical epidemiologist with the Office of Antibiotic Stewardship in the Division of Healthcare Quality Promotion at the Centers Disease Control and Prevention (CDC).

Dr. Fleming-Dutra is a pediatrician and pediatric emergency medicine physician and has focused on infectious diseases epidemiology and antibiotic stewardship in the outpatient setting in her career at CDC.

Join Dr. Fleming-Dutra as she discusses a recent study published by the Journal of the American Medical Association, was released showing that at least 30 percent of all prescriptions written in doctors’ offices and emergency rooms are completely unnecessary. So how do we use these alarming results to transform the culture of over-prescribing Dr. Katherine Fleming-Dutra, M.D., will:

  • Give a detailed explanation of the study results, and provide an in-depth review of specific findings;
  • Highlight what CDC is doing to promote antibiotic stewardship across healthcare settings, and
  • Identify what clinicians, other health care professionals, and patients can do to improve antibiotic prescribing, therefore fighting antibiotic resistance.

 

C diff Radio™ Live Broadcast AND Podcasts

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An educational program that is dedicated to  C. difficile Infections  and more–

 

Click On The LOGO  Above And Enjoy Listening To the Live Broadcasts In the C. diff. Spores and More Podcast Library.

 

Live Broadcast airs
on Tuesdays at:    10a PT,    11a MT,   12p CT,    1p ET

We are pleased to share  “C. diff. Spores and More ™”  with you because, as advocates of  C. diff.,  we know the importance of this cutting-edge new weekly radio show  and what it means for our Foundation’s community worldwide.–

Hard Facts: Deaths and illnesses are much higher than reports have shown. Nearly half a million Americans suffered from Clostridium difficile (C. diff.) infections in a single year according to a study released today, February 25, 2015, by the Centers for Disease Control and Prevention (CDC).

• More than 100,000 of these infections developed among residents of U.S. nursing homes.

Approximately 29,000 patients died within 30 days of the initial diagnosis of a C. diff. infection. Of these 29,000 – 15,000 deaths were estimated to be directly related to a
C. diff. infection. Therefore; C. diff. is an important cause of infectious disease death in the U.S.

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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. Approximately
two-thirds of C. diff. infections were found to be associated with an inpatient stay in a health care facility, only 24% of the total cases occurred in patients while they were hospitalized. The study also revealed that almost as many cases occurred in nursing homes as in hospitals and the remainder of individuals acquired the
Healthcare-Associated infection, C. diff., recently discharged from a health care facility.

This new study finds that 1 out of every 5 patients with the Healthcare-Associated Infection (HAI), C. diff., experience a recurrence of the infection and 1 out of every 9 patients over the age of 65 diagnosed with a HAI – C. diff. infection died within 30 days of being diagnosed. Older Americans are quite vulnerable to this life-threatening diarrhea infection. The CDC study also found that women and Caucasian individuals are at an increased risk of acquiring a C. diff. infection. The CDC Director, Dr. Tom Frieden, MD, MPH said, “C. difficile infections cause immense suffering and death for thousands of Americans each year.” “These infections can be prevented by improving antibiotic prescribing and by improving infection control in the health care system. CDC hopes to ramp up prevention of this deadly infection by supporting State Antibiotic Resistance Prevention Programs in all 50 states.”

“This does not include the number of C. diff. infections taking place and being treated in other countries.”  “The  C Diff Foundation supports hundreds of communities by sharing the Foundation’s mission and  raising C. diff. awareness to healthcare professionals, individuals, patients, families,  and communities working towards a shared goal ~  witnessing a reduction of newly diagnosed C. diff. cases by 2020 .”   ” The C Diff Foundation volunteer Advocates are greatly appreciated and continue to create positive changes by sharing their time  aiding in the success of our mission “Raising C. diff. awareness ™”  worldwide.

C. diff. Spores and More ™“ spotlights world renowned topic experts, research scientists, healthcare professionals, organization representatives, C. diff. survivors, board members, and their volunteers who are all creating positive changes in the
C. diff.
community and more.

Through their interviews, the C Diff Foundation mission will connect, educate, and empower listeners worldwide.

Questions received through the show page portal will be reviewed and addressed  by the show’s Medical Correspondent, Dr. Fred Zar, MD, FACP,  Dr. Fred Zar is a Professor of Clinical Medicine, Vice HeZarPhotoWebsiteTop (2)ad for Education in the Department of Medicine, and Program Director of the Internal Medicine Residency at the University of Illinois at Chicago.  Over the last two decades he has been a pioneer in the study of the treatment of Clostridium difficile disease and the need to stratify patients by disease severity.

 

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Programming for C. diff. Spores and More ™ is made possible through our official Corporate Sponsor;  Clorox Healthcare

We look forward to sharing time with our worldwide listeners when we return in January, Season III. 

Until then………………

We send out get-well wishes to everyone being treated for and recovering from a C. difficile infection and all wellness draining illnesses worldwide.

“None of us can do this alone – All of us can do this together!”

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:

http://www.voiceamerica.com/episode/90312/using-antibiotics-wisely-how-you-can-help-in-the-fight-against-antibiotic-resistance

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:

https://cdifffoundation.org/2016/04/15/idsa-and-shea-release-new-antibiotic-stewardship-guidelines/

 

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:

http://www.cidrap.umn.edu/news-perspective/2016/04/report-antibiotic-stewardship-programs-lower-infections-improve-care

Hospital Collaborative Measures Show Positive Results In Driving Down C difficile Infection (CDI) Rates In New York

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In the news

Each hospital had been trying to combat C. difficile on its own, but they were often outwitted by the hardy spore, which is fueled by overuse of antibiotics, spread by hands  and able to survive on bed rails, call buttons and doorknobs for as long as five months if not longer and cleaned off.

Plus, it was traveling: Patients in one hospital or nursing home were often discharged and then admitted to another. Dealing with the mess was costing the hospitals an estimated $4 million to $5 million a year.

So they did something rare for competing health-care systems. Four hospitals joined forces to beat back the debilitating bug, forming a C. difficile prevention collaborative. Six nursing homes that share patients with the hospitals and had a huge C. difficile problem of their own then formed a separate alliance.

It paid off: In the 12 months ended in September 2015, rates of C. difficile infections fell 36% from 2011 levels across the hospitals, which initially were in three but are now in two health-care systems: the University of Rochester Medical Center and Rochester Regional Health System.

“It’s not very simple—you have to have a multidisciplinary approach to prevent this infection,” says Ghinwa Dumyati, who leads both the hospital and nursing-home collaboratives as an infectious-disease physician with the Center for Community Health at the University of Rochester Medical Center. “We needed to work together.”

A good cleaning

Hospitals compete intensely for patients, doctors and insurance dollars, but when it comes to safety, they are increasingly collaborating to solve common problems, according to Arjun Srinivasan, an expert at the Centers for Disease Control and Prevention in the prevention of health-care-associated infections. The CDC says working together allows hospitals to more effectively fight infections caused by drug-resistant bacteria and C. difficile because the bugs are intractable and the difficulties each facility faces are similar. Plus, Dr. Srinivasan says, “hospitals share those patients.”

New federal requirements to improve health-care quality, such as public reporting of health-care-associated infections and penalties for readmissions, also are prodding hospitals to collaborate more on safety issues, Dr. Srinivasan and hospital executives say.

C. difficile is the most common pathogen causing health-care-associated infections in U.S. hospitals, according to the CDC. It led to approximately 453,000 infections and 29,000 deaths in the U.S. in 2011, according to a study last year in the New England Journal of Medicine.

Infections occur when someone ingests C. difficile and takes antibiotics that wipe out the good bacteria in their gut. That leaves the C. difficile to flourish in the colon, producing diarrhea that can last for weeks or months. The elderly are particularly at risk of infection because their immune systems may be weak, and they are frequent users of hospitals and nursing homes.

Rochester’s C. difficile-prevention collaborative began in 2011, funded by the health-care

systems involved and a large regional insurer, Excellus BlueCross BlueShield. It grew out of an earlier initiative that Dr. Dumyati had led that sharply reduced bloodstream infections from central lines, or catheters, inserted in the body. This time, the collaborative—Dr. Dumyati, along with doctors, infection preventionists and others from the hospitals—

chose to target C. difficile. “We knew we had a lot of cases,” she says.

First, the collaborative focused on cleaning procedures. The hospitals taught staff to scrub long and hard with bleach wipes to get rid of super-resilient C. difficile in hospital rooms. “Just like if you’re washing a plate, you have to apply pressure to get food off,” says Jeanna Hibbert, who cleans rooms at Strong Memorial Hospital, one of the four participating hospitals.

They also introduced inspections of cleaned rooms, using a tool that checks for even small amounts of contamination. “That was new and extraordinarily helpful,” says Robert Panzer, chief quality officer and associate vice president at Strong Memorial.

Each hospital made changes in its own way, and borrowed ideas from the others. Strong Memorial dedicated a crew to clean the rooms of discharged C. difficile patients after determining that it takes an hour and half—twice as long as normal—to properly clean them, adopting a practice from its sister, Highland Hospital.

After the collaborative laid out a policy for treating less severe forms of pneumonia, Strong Memorial pharmacists changed an electronic order form for antibiotics to prevent physicians treating those infections from prescribing a class of drugs linked to C. difficile infection without special approval, says Dr. Dumyati.

Across town at Rochester General Hospital, staff promoted the new pneumonia policy in a newsletter for doctors. Use of the desired antibiotic, doxycycline, for pneumonia more than tripled in a year; use of the one it replaced fell 48%, the hospital says.

The team at Rochester General also created a poster with new guidelines for diagnosing and treating urinary-tract infections after the collaborative determined that five out of six of its hospital patients treated for them don’t actually have them. Dr. Dumyati adopted it for use in the nursing homes she had started to work with, with a grant from the state.

The new policies have helped Rochester General strengthen an antibiotic stewardship program it adopted a few years ago, in which a team of experts reviews antibiotic prescriptions, says Maryrose Laguio-Vila, the program’s director. “We gain insight into whether what we’re doing is along the right track or can be tweaked in a certain way.”

The collaborative has helped all of the hospitals improve their practices and patient care, says Nayef El-Daher, chief of infectious disease at Unity Hospital. “When we started the project, every one of us had [our] own ideas and protocols,” he says.

The next front

Dr. Dumyati feeds data on C. difficile infection rates and other measures every quarter to each of the hospitals, so that they can see how they’re doing. “The data really drive where we go next,” she says.

Next, she hopes to take the new policies to doctors’ and dentists’ offices. About 35% of all C. difficile infections aren’t linked to stays in hospitals or long-term-care facilities, according to the NEJM study.

“It’s fairly clear that you have to work with the nursing homes and you have to work across the community to make progress,” says Mark Shelly, chief of infectious disease at Highland Hospital. “Otherwise we’ll be pointing across the fence for a long time.”

 

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

 

http://www.wsj.com/articles/rochester-hospitals-unite-to-defeat-a-common-foe-c-difficile-1455592271

Using Antibiotics Wisely, How Everyone Can Help In the Fight Against Antibiotic Resistance Worldwide

Did you have the opportunity to listen  to the live broadcast on “C. diff. Spores and More Global Broadcasting Network”  on Tuesday, February 9th, 2016 with guests Dr. Lori Hicks and Dr. Arjun Srinivasan from  the Centers of Disease Control and Prevention (CDC) ?

Dr. Hicks and Dr. Srinivasan discussed how to use antibiotics wisely and how everyone can help in the fight against antibiotic-resistance.

This important  information  is now available to you on demand by clicking directly on the logo below

 

cdiffRadioLogoMarch2015

For additional information on Inpatient Antibiotic Stewardship please click on the following link:

http://www.cdc.gov/getsmart/healthcare/inpatient-stewardship.html

 

To access the CDC Get Smart Program, please click on the following link to be redirected:

http://www.cdc.gov/getsmart/index.html

 

 

C. diff. Spores and More” programming is brought to you by VoiceAmerica  and sponsored by Clorox Healthcare

For more information please visit the C. diff. Spores and More program page:

https://cdifffoundation.org/c-diff-radio/

C diff Spores and More Global Broadcasting Network and Guests Dr. Srinivasan and Dr. Hicks of the CDC Discuss Antibiotic Resistance

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C. diff. Spores and More , Global Broadcasting Network – innovative and educational interactive healthcare talk radio show discuss antibiotic resistance and what everyone can do to join in the fight against it with guests Dr. Arjun Srinivasan and
Dr. Lauri Hicks on Tuesday, February 9th at 10 AM Pacific Time on VoiceAmerica Health and Wellness Channel

Bringing guests together, such as Dr. Arjun Srinivasan, MD and Dr. Lauri Hicks, DO from the Center of Disease Control and Prevention (CDC), one of the leading government healthcare organizations in the U.S., and internationally recognized experts on antibiotic resistance has built a loyal listenership and continue to inform and educate listeners’ worldwide.

C.diff. Spores and More” is broadcast live every Tuesday at 10 AM Pacific Time on the VoiceAmerica Health and Wellness channel, officially sponsored by Clorox Healthcare. Archived C. diff. Spores and More shows can be found Here.

“I am so proud to be the Senior Executive Producer of the “C. diff. Spores and More,” program as it continues to raise awareness, on a global level, of the overuse of antibiotics. Having guests; Dr. Arjun Srinivasan, MD and Dr. Lauri Hicks, DO truly affect change in both the leadership and education guiding the public and raising awareness in many areas of health care,” stated Robert Ciolino, Senior Executive Producer VoiceAmerica.

About The C diff Foundation Executive Director
Nancy C Caralla, hosts “C. diff. Spores and More” Global Broadcasting Network with a team focus on educating, and advocating for C. diff. infection prevention, treatments, and environmental safety – and more — worldwide.

For information please visit www.cdifffoundation.org

Listen in on Tuesday, February 9th at 10:00 Pacific Time–

https://cdifffoundation.org/c-diff-radio/