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  • 1
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 7, No. Supplement_1 ( 2020-12-31), p. S445-S445
    Abstract: Patients with community-acquired pneumonia (CAP) who are hospitalized and treated with antibiotics may carry an increased risk for developing Clostridioides difficile infection (CDI). Accurate risk estimation tools are needed to guide monitoring and CDI mitigation efforts. We aimed to identify patient-specific risk factors associated with CDI among hospitalized patients with CAP. Methods Design: retrospective case-control study of hospitalized patients who received CAP-directed antibiotic therapy between 1/1/2014 and 5/29/2018. Cases were hospitalized CAP patients who developed CDI post-admission. Control patients did not develop CDI and were selected at random from CAP patients hospitalized during this period. Variables: comorbidities, laboratory results, vital signs, severity of illness, prior hospitalization, and past antibiotic use. Propensity-score weights: identified via structural decomposition analysis of pre-treatment variables. Analysis: weighted classification tree models that predicted any CDI, hospital-onset CDI, and any healthcare-associated CDI according to CAP antibiotic treatment. Performance: percent accuracy in classification (PAC) and weighted positive (PPV) and negative predictive values (NPV). Modeling: completed using the ODA package (v1.0.1.3) for R (v3.5.1). Results A total of 32 cases and 232 controls were identified. Sixty pre-treatment variables were screened. Structural decomposition analysis, completed in two stages, identified prior hospitalization (OR 6.56, 95% CI: 3.01-14.31; PAC: 80.3%) and BUN greater than 29 mg/dL (OR 11.67, 95% CI: 2.41-56.5; PAC: 80.8%) as propensity-score weights. With respect to CDI, receipt of broad-spectrum anti-pseudomonal antibiotics was significantly (all P’s & lt; 0.05) associated with any CDI (NPV: 90.29%, PPV: 27.94%), hospital-onset CDI (NPV: 97.53%, PPV: 26.86%), and healthcare-associated CDI (NPV: 92.89%, PPV: 27.94%). Conclusion We identified risk factors available at hospital admission and empiric use of broad-spectrum Gram-negative antibiotics as being associated with the development of CDI. Model PPVs were over two-fold greater than our sample base rate. Increased monitoring and avoidance of overly broad antibiotic use in high-risk patients appears warranted. Disclosures All Authors: No reported disclosures
    Type of Medium: Online Resource
    ISSN: 2328-8957
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
    detail.hit.zdb_id: 2757767-3
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  • 2
    Online Resource
    Online Resource
    American Veterinary Medical Association (AVMA) ; 2023
    In:  Journal of the American Veterinary Medical Association ( 2023-09-01), p. 1-9
    In: Journal of the American Veterinary Medical Association, American Veterinary Medical Association (AVMA), ( 2023-09-01), p. 1-9
    Abstract: To characterize clinician preferences and justification for preferred methods for managing canine idiopathic acute diarrhea (IAD) and compare results to evidence-based literature. sample 284 surveys from veterinarians in small animal first-opinion practice. Methods Veterinarians were asked to complete a survey (61 questions) including background demographic information, practice type and location, duration in practice, and management questions for canine IAD pertaining to nutritional, probiotic, antimicrobial, antidiarrheal, benign neglect, and other therapies. The survey was available between May 5, 2021, and August 30, 2021. Results Respondents reported that their preferred first-line therapy for canine IAD included dietary modification (41.3% of respondents), probiotics (20.1%), antimicrobials (21.2%), antidiarrheal medications (13.0%), and benign neglect (4.3%). The percentage of respondents who reported each therapy as either extremely effective or very effective for canine IAD varied by treatment, as follows: antimicrobials (75.2%), dietary modification (59.13%), antidiarrheal medications (42.5%), probiotics (35.5%), and benign neglect (6.52%). Perceptions of effectiveness, efficiency of treatment, and clinician justification for use were variable among treatments. Reported practice styles were occasionally in disagreement with evidence-based methods of canine IAD management. Clinical Relevance Current clinical management of IAD is not consistently in agreement with evidence-based recommendations. The results of this study underscore the continued need to evaluate veterinary prescribing practice trends compared to evidence-based recommendations and promote dissemination of new information.
    Type of Medium: Online Resource
    ISSN: 0003-1488
    Language: Unknown
    Publisher: American Veterinary Medical Association (AVMA)
    Publication Date: 2023
    detail.hit.zdb_id: 2904887-4
    SSG: 22
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  • 3
    In: American Journal of Infection Control, Elsevier BV, Vol. 47, No. 6 ( 2019-06), p. S15-
    Type of Medium: Online Resource
    ISSN: 0196-6553
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2019
    detail.hit.zdb_id: 2011724-3
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  • 4
    In: Infection Control & Hospital Epidemiology, Cambridge University Press (CUP), Vol. 40, No. 3 ( 2019-03), p. 269-275
    Abstract: We evaluated whether a diagnostic stewardship initiative consisting of ASP preauthorization paired with education could reduce false-positive hospital-onset (HO) Clostridioides difficile infection (CDI). Design: Single center, quasi-experimental study. Setting: Tertiary academic medical center in Chicago, Illinois. Patients: Adult inpatients were included in the intervention if they were admitted between October 1, 2016, and April 30, 2018, and were eligible for C. difficile preauthorization review. Patients admitted to the stem cell transplant (SCT) unit were not included in the intervention and were therefore considered a contemporaneous noninterventional control group. Intervention: The intervention consisted of requiring prescriber attestation that diarrhea has met CDI clinical criteria, ASP preauthorization, and verbal clinician feedback. Data were compared 33 months before and 19 months after implementation. Facility-wide HO-CDI incidence rates (IR) per 10,000 patient days (PD) and standardized infection ratios (SIR) were extracted from hospital infection prevention reports. Results: During the entire 52 month period, the mean facility-wide HO-CDI-IR was 7.8 per 10,000 PD and the SIR was 0.9 overall. The mean ± SD HO-CDI-IR (8.5 ± 2.0 vs 6.5 ± 2.3; P 〈 .001) and SIR (0.97 ± 0.23 vs 0.78 ± 0.26; P = .015) decreased from baseline during the intervention. Segmented regression models identified significant decreases in HO-CDI-IR ( P step = .06; P trend = .008) and SIR ( P step = .1; P trend = .017) trends concurrent with decreases in oral vancomycin ( P step 〈 .001; P trend 〈 .001). HO-CDI-IR within a noninterventional control unit did not change ( P step = .125; P trend = .115). Conclusions: A multidisciplinary, multifaceted intervention leveraging clinician education and feedback reduced the HO-CDI-IR and the SIR in select populations. Institutions may consider interventions like ours to reduce false-positive C. difficile NAAT tests.
    Type of Medium: Online Resource
    ISSN: 0899-823X , 1559-6834
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2019
    detail.hit.zdb_id: 2106319-9
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