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Content Update

Jully 3, 2018

Risk of Methicillin-resistant Staphylococcus aureus and Clostridium difficile Infection with Documented Penicillin Allergy: Many patients are labelled as penicillin allergic but do not have true immediate penicillin hypersensitivity. This can lead to unnecessary administration of broad-spectrum antimicrobials, which can promote emergence of antimicrobial resistance (eg, MRSA) and development of healthcare-associated infections such as C. difficile. A recent report demonstrated that patients with documented penicillin allergy have a higher risk of infections with MRSA and C. difficile. The report supports the principle of using the most narrow spectrum antimicrobial that is effective to treat an infection, and that unnecessary use of broad-spectrum antimicrobials increases the risk of bacterial resistance and emergence of superinfections. When penicillin allergy is suspected, efforts should be made to determine if the patient experienced an immediate hypersensitivity reaction.

Content Update

April 8, 2018

2017 Updated Guidelines for Clostridium difficile Infections: The Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America released updated guidelines for Clostridium difficile infections (CDI) in adults and children. The document is a comprehensive update of the 2010 guidelines for epidemiology, diagnosis, and treatment and now includes recommendations for children. The reader is advised to consult the original source for the full recommendations.

Content Update

May 11, 2017

Vancomycin Reduces Mortality Rates in Patients with Severe Clostridium Difficile Infection:

A retrospective analysis found that the 30-day mortality risk in patients with severe Clostridium difficile infection (CDI) was significantly lower in patients treated with vancomycin compared to metronidazole.

There was no difference in the risk of CDI recurrence between the two treatments. The study provides additional evidence that vancomycin should be the preferred treatment for patients with severe CDI.

PATIENT CARE PROCESS

Patient Care Process for Clostridium difficile Infections

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Collect

  • Patient characteristics (e.g., age, sex)

  • Patient medical history (personal and family), including any previous episodes of CDI

  • Social history (e.g., tobacco/ethanol use) and dietary habits

  • Current medications including OTC, herbal products, dietary supplements, acid suppressive medication, and previous antibiotic use (within the past 3 months)

  • Characteristics of diarrhea including onset, number of episodes per day, and presence of blood

  • Objective data

    • Blood pressure (BP), heart rate (HR), respiratory rate (RR), height, weight, O2-saturation

    • Laboratory tests, including white blood cell count (WBC) and serum creatinine (SCr)

    • Stool sample to be tested for Clostridium difficile toxins

    • Radiographic abdominal imaging if concern for ileus or megacolon

Assess

  • Hemodynamic stability (e.g. systolic BP <90 mm="" hg,="" hr="">110 bpm, O2-sat <90%, RR)

  • Radiographic studies for the presence of ileus, megacolon, or perforation

  • Presence of CDI risk factors (age, antibiotic use, recent healthcare exposure, chemotherapy, GI surgery, tube feeding, acid suppressive medications)

  • Ability to stop offending antibiotic agent if applicable

  • Ability/willingness to pay for first-line treatment options

  • Ability/willingness to try investigational therapies such as fecal microbiota transplant (if applicable for recurrent disease)

  • Ability/willingness to pay for adjunctive therapy with bezlotoxumab

  • Plan*...

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