Journal Article10.1086/677151
Clostridium difficile infections in Veterans Health Administration acute care facilities.
TL;DR: VA long-term care facility CDI rates were comparable to those in recent reports from other long- term care facilities, and efforts to decrease CDI levels are necessary as part of a coordinated approach to decrease healthcare-associated infections.
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Abstract: OBJECTIVE A nationwide initiative was implemented in February 2014 to decrease Clostridium difficile infections (CDI) in Veterans Affairs (VA) long-term care facilities. We report a baseline of national CDI data collected during the 2 years before the Initiative. METHODS Personnel at each of 122 reporting sites entered monthly retrospective CDI case data from February 2012 through January 2014 into a national database using case definitions similar to those used in the National Healthcare Safety Network Multidrug-Resistant Organism/CDI module. The data were evaluated using Poisson regression models to examine infection occurrences over time while accounting for admission prevalence and type of diagnostic test. RESULTS During the 24-month analysis period, there were 100,800 admissions, 6,976,121 resident days, and 1,558 CDI cases. The pooled CDI admission prevalence rate (including recurrent cases) was 0.38 per 100 admissions, and the pooled nonduplicate/nonrecurrent community-onset rate was 0.17 per 100 admissions. The pooled long-term care facility–onset rate and the clinically confirmed (ie, diarrhea or evidence of pseudomembranous colitis) long-term care facility–onset rate were 1.98 and 1.78 per 10,000 resident days, respectively. Accounting for diagnostic test type, the long-term care facility–onset rate declined significantly (P=.05), but the clinically confirmed long-term care facility–onset rate did not. CONCLUSIONS VA long-term care facility CDI rates were comparable to those in recent reports from other long-term care facilities. The significant decline in the long-term care facility-onset rate but not in the clinically confirmed long-term care facility–onset rate may have been due to less testing of asymptomatic patients. Efforts to decrease CDI rates in long-term care facilities are necessary as part of a coordinated approach to decrease healthcare-associated infections. Infect. Control Hosp. Epidemiol. 2016;37(3):295–300
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Citations
Global burden of Clostridium difficile infections: a systematic review and meta-analysis.
Evelyn Balsells,Ting Shi,Callum J. Leese,Iona Lyell,John Burrows,Camilla Wiuff,Harry Campbell,Moe H Kyaw,Harish Nair +8 more
TL;DR: The widespread burden of disease of C. difficile, evidence gaps, and the need for sustainable surveillance of CDI in the health care setting and the community are highlighted.
Current Trends in the Epidemiology and Outcomes of Clostridium difficile Infection
TL;DR: The impact of antibiotics as a risk factor for new-onset CDI is well established; however, recognizing classes of antibiotics with the highest risks and reducing unnecessary antibiotic use are important strategies for prevention of CDI and subsequent recurrence.
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Comparative Effectiveness of Vancomycin and Metronidazole for the Prevention of Recurrence and Death in Patients With Clostridium difficile Infection.
Vanessa Stevens,Richard E. Nelson,Elyse M. Schwab-Daugherty,Karim Khader,Makoto Jones,Kevin A. Brown,Tom Greene,Lindsay D. Croft,Melinda M. Neuhauser,Peter A. Glassman,Matthew Bidwell Goetz,Matthew H. Samore,Michael Rubin +12 more
TL;DR: This retrospective, propensity-matched cohort study evaluated patients treated for CDI, defined as a positive laboratory test result for the presence of C difficile toxins or toxin genes in a stool sample, in the US Department of Veterans Affairs health care system from January 1, 2005, through December 31, 2012 to evaluate the risk of recurrence and all-cause 30-day mortality.
Burden of Clostridioides difficile infection (CDI) - a systematic review of the epidemiology of primary and recurrent CDI.
TL;DR: A systematic literature review (SLR) summarises the current evidence on the epidemiology and clinical burden of CDI, including the most widely reported findings were incidence and risk factors for CDI and rCDI.
A Report of the Efforts of the Veterans Health Administration National Antimicrobial Stewardship Initiative
Allison Kelly,Makoto Jones,Kelly Echevarria,Stephen M. Kralovic,Matthew H. Samore,Matthew Bidwell Goetz,Karl Madaras-Kelly,Loretta A. Simbartl,Anthony P. Morreale,Melinda M. Neuhauser,Gary A. Roselle +10 more
TL;DR: The VHA has shown that improving antimicrobial usage in a large healthcare system may be achieved through national guidance and resources with local implementation of antimicrobial stewardship programs.
References
Clinical Practice Guidelines for Clostridium difficile Infection in Adults: 2010 Update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA)
Stuart H. Cohen,Dale N. Gerding,Stuart Johnson,Ciaran P. Kelly,Vivian G. Loo,L. Clifford McDonald,Jacques Pépin,Mark H. Wilcox +7 more
TL;DR: This guideline updates recommendations regarding epidemiology, diagnosis, treatment, and infection control and environmental management of Clostridium difficile.
Burden of Clostridium difficile Infection in the United States
Fernanda C. Lessa,Yi Mu,Wendy Bamberg,Zintars G. Beldavs,Ghinwa Dumyati,John R. Dunn,Monica M. Farley,Stacy Holzbauer,James I. Meek,Erin C Phipps,Lucy E. Wilson,Lisa G. Winston,Jessica Cohen,Brandi Limbago,Scott K. Fridkin,Dale N. Gerding,L. Clifford McDonald +16 more
TL;DR: In this article, the authors used regression models to calculate estimates of national incidence and total number of infections, first recurrences, and deaths within 30 days after the diagnosis of C. difficile infection.
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Summary of notifiable diseases--United States, 2012.
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TL;DR: The Summary of notifiable diseases--United States, 2012 contains the official statistics, in tabular and graphic form, for the reported occurrence of nationally notifiable infectious diseases in the United States for 2012.
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TL;DR: Genetically diverse sources, in addition to symptomatic patients, play a major part in C. difficile transmission, which suggests a considerable reservoir of C. Difficile infection identified in health care settings or in the community in Oxfordshire.
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