Incidence of Clostridium difficile infections in patients receiving antimicrobial and acid-suppression therapy.

Abstract:

STUDY OBJECTIVES:To determine the incidence of Clostridium difficile infection (CDI) at one community hospital by identifying patients with stool samples positive for C. difficile toxin A or B, and to compare the incidence with a 2008 national estimate; and to determine which patient characteristics and concomitant antimicrobial and acid-suppression drugs are risk factors for the development of CDI. DESIGN:Retrospective, single-center, medical record review. SETTING:350-bed community hospital. PATIENTS:A total of 11,010 admissions between January 1, 2009, and December 31, 2009; 115 of these patients had stool samples positive for C. difficile toxin A or B. MEASUREMENTS AND MAIN RESULTS:All C. difficile toxin A and B enzyme immunoassay tests were performed by a central laboratory. The incidence of CDI was 10.4 cases/1000 patient admissions, which was significantly lower than the overall incidence reported in a 2008 national survey of 13.1 CDI cases/1000 patient admissions (p=0.021). Demographic and clinical data of the patients with CDI were collected by using electronic medical records. Patients were more likely to be elderly and female, and to have developed CDI during hospitalization. Of the 115 patients, 95 (82.6%) received acid-suppression therapy and 91 (79.1%) received antimicrobials. Of the patients receiving acid-suppression therapy, 72 (75.8%) received a proton pump inhibitor during their hospitalization, and 49 (51.6%) received both a proton pump inhibitor and an antibiotic. The most frequently used antibiotics in this population were fluoroquinolones, cephalosporins, and carbapenems, with a significantly larger proportion of patients who received carbapenems developing CDI compared with the other classes of antibiotics (p≤0.05 for both comparisons). Patients receiving antimicrobial and acid-suppression therapy were more likely to develop CDI than those who did not receive these drugs. CONCLUSION:The incidence of CDI in 2009 at one community hospital was significantly lower than a 2008 national estimate. Antimicrobial and acid-suppression therapies--in particular, combinations of fluoroquinolones, cephalosporins, carbapenems, and proton pump inhibitors--were found to be risk factors for the development of CDIs in hospitalized patients.

journal_name

Pharmacotherapy

journal_title

Pharmacotherapy

authors

King RN,Lager SL

doi

10.1592/phco.31.7.642

subject

Has Abstract

pub_date

2011-07-01 00:00:00

pages

642-8

issue

7

eissn

0277-0008

issn

1875-9114

journal_volume

31

pub_type

杂志文章
  • Safe administration of iron sucrose in a patient with a previous hypersensitivity reaction to ferric gluconate.

    abstract::A 67-year-old woman with iron deficiency anemia required parenteral iron therapy and was treated with intravenous ferric gluconate. She tolerated the first dose, but after the second dose, she developed a tingling feeling all over her body, along with swelling in her hands and feet, and a rash with hives over most of ...

    journal_title:Pharmacotherapy

    pub_type: 杂志文章

    doi:10.1592/phco.27.4.613

    authors: Sane R,Baribeault D,Rosenberg CL

    更新日期:2007-04-01 00:00:00

  • Falsely low hemoglobin A1c levels in a patient receiving ribavirin and peginterferon alfa-2b for hepatitis C.

    abstract::The effect of treatment for hepatitis C viral infection on hemoglobin A(1c) (A1C) levels is not well described in the literature. We describe a 59-year-old man with type 2 diabetes mellitus whose A1C level became falsely low when ribavirin and peginterferon alfa-2b therapy were started for treatment of hepatitis C. Af...

    journal_title:Pharmacotherapy

    pub_type: 杂志文章

    doi:10.1592/phco.29.1.121

    authors: Gross BN,Cross LB,Foard JC,Wood YA

    更新日期:2009-01-01 00:00:00

  • Endothelin-1 and endothelin receptor antagonists as potential cardiovascular therapeutic agents.

    abstract::Endothelin (ET)-1 is an endothelium-derived peptide with potent vasoconstrictor and proliferative properties. The ET system is activated in several cardiovascular disease states associated with functional and structural vascular changes, including hypertension and heart failure. The two ET receptor subtypes are known ...

    journal_title:Pharmacotherapy

    pub_type: 杂志文章,评审

    doi:10.1592/phco.22.1.54.33505

    authors: Ergul A

    更新日期:2002-01-01 00:00:00

  • Delaying the onset of type 2 diabetes mellitus in patients with prediabetes.

    abstract::The frequency of type 2 diabetes mellitus is increasing at an alarming rate. Prediabetes, also referred to as impaired glucose tolerance (IGT) and/or impaired fasting glucose, is a major risk factor for development of type 2 diabetes mellitus. In addition, IGT has been associated with an increased risk of cardiovascul...

    journal_title:Pharmacotherapy

    pub_type: 杂志文章,评审

    doi:10.1592/phco.24.4.362.33170

    authors: Irons BK,Mazzolini TA,Greene RS

    更新日期:2004-03-01 00:00:00

  • Postoperative atrial fibrillation: role of inflammatory biomarkers and use of colchicine for its prevention.

    abstract::Postoperative atrial fibrillation (POAF) is the most common complication following cardiac surgery, occurring in up to 65% of cardiac surgical patients. It is a condition associated with increased morbidity, increased length of hospital stay, and increased health care costs. One of the many potential causes of POAF is...

    journal_title:Pharmacotherapy

    pub_type: 杂志文章,评审

    doi:10.1002/phar.1485

    authors: Worden JC,Asare K

    更新日期:2014-11-01 00:00:00

  • The antioxidant vitamins: impact on atherosclerosis.

    abstract::Atherosclerosis, the great killer of Western society, probably is initiated when the balance of subendothelial lipoproteins and oxidation potential is upset. Oxidation products, especially oxidized low-density lipoprotein, set into motion the cascading of numerous pathways, culminating in the fibrous atherosclerotic p...

    journal_title:Pharmacotherapy

    pub_type: 杂志文章,评审

    doi:

    authors: Meyers DG,Maloley PA

    更新日期:1993-11-01 00:00:00

  • Evaluation and Treatment of Acute and Subacute Hearing Loss: A Review of Pharmacotherapy.

    abstract::Among various forms of hearing loss, there are acute (within 72 hrs) or subacute (weeks to months) presentations that may be reversible with early pharmacological intervention. The workup of a patient presenting with hypoacusia includes the usual history and physical examination in conjunction with an audiometric asse...

    journal_title:Pharmacotherapy

    pub_type: 杂志文章,评审

    doi:10.1002/phar.2044

    authors: Fazel MT,Jedlowski PM,Cravens RB Jr,Erstad BL

    更新日期:2017-12-01 00:00:00

  • Therapeutic drug monitoring of continuous-infusion acylovir for disseminated herpes simplex virus infection in a neonate receiving concurrent extracorporeal life support and continuous renal replacement therapy.

    abstract::Disseminated herpes simplex virus (HSV) infection in neonates represents a devastating entity that yields high mortality. Acyclovir is the primary antiviral agent used to treat life-threatening HSV infections in neonates; however, even though the agent has reduced morbidity overall from these infections, mortality wit...

    journal_title:Pharmacotherapy

    pub_type: 杂志文章

    doi:10.1002/phar.1526

    authors: Cies JJ,Moore WS 2nd,Miller K,Small C,Carella D,Conley S,Parker J,Shea P,Chopra A

    更新日期:2015-02-01 00:00:00

  • Pharmacologic interventions for the management of critical bleeding.

    abstract::Hospital pharmacists are often consulted for their knowledge about coagulation and therapeutic interventions for the management of critical bleeding. Many pharmacotherapies are available for this purpose, both systemic and topical, and others are in development. These agents and their mechanisms of action are reviewed...

    journal_title:Pharmacotherapy

    pub_type: 杂志文章,评审

    doi:10.1592/phco.27.9part2.69S

    authors: Voils S

    更新日期:2007-09-01 00:00:00

  • Limitations of traditional anticoagulants.

    abstract::Warfarin and unfractionated heparin have been in clinical use for more than 50 years. Both are effective anticoagulants, but their use is associated with a number of impediments, including the need for intensive coagulation monitoring, wide variation in dose-response relationships, multiple drug interactions (in the c...

    journal_title:Pharmacotherapy

    pub_type: 杂志文章,评审

    doi:10.1592/phco.24.10.62s.36120

    authors: Hawkins D

    更新日期:2004-07-01 00:00:00

  • Novel oral anticoagulants and their role in clinical practice.

    abstract::The complexities of oral anticoagulation with warfarin have led to the search for more practical alternative agents. Novel direct factor IIa inhibitors and direct factor Xa inhibitors currently in development can be administered at a fixed dose and do not require routine coagulation monitoring and ongoing dosage adjus...

    journal_title:Pharmacotherapy

    pub_type: 杂志文章,评审

    doi:10.1592/phco.31.12.1175

    authors: Wittkowsky AK

    更新日期:2011-12-01 00:00:00

  • Vitamin K to reverse excessive anticoagulation: a review of the literature.

    abstract::We conducted an extensive literature review to evaluate the appropriate use, route, and dose of vitamin K to reverse excessive anticoagulation. Issues such as sample size, study design, different patient populations, and various study end points confounded results. Of 18 studies published, 8 enrolled 229 patients to e...

    journal_title:Pharmacotherapy

    pub_type: 杂志文章,评审

    doi:10.1592/phco.19.18.1415.30896

    authors: Taylor CT,Chester EA,Byrd DC,Stephens MA

    更新日期:1999-12-01 00:00:00

  • Aminoglycoside pharmacokinetic parameters in neurocritical care patients undergoing induced hypothermia.

    abstract:STUDY OBJECTIVE:To determine the effects of mild-to-moderate induced hypothermia-a neuroprotectant and/or therapeutic strategy for the management of intracranial hypertension in neurologically injured patients-on the pharmacokinetics of aminoglycoside therapy. DESIGN:Pharmacokinetic analysis. SETTING:Critical care un...

    journal_title:Pharmacotherapy

    pub_type: 杂志文章

    doi:10.1592/phco.30.7.654

    authors: Mercer JM,Neyens RR

    更新日期:2010-07-01 00:00:00

  • Octreotide-Associated Neutropenia.

    abstract::Drug-induced neutropenia and agranulocytosis are rare adverse events but can be fatal. Neutropenia can be induced by a myriad of drugs from almost every pharmacologic class. Octreotide is a somatostatin analog that has been used to treat variceal bleeding, acromegaly, and severe diarrhea associated with metastatic tum...

    journal_title:Pharmacotherapy

    pub_type:

    doi:10.1002/phar.1942

    authors: Tse SS,Kish T

    更新日期:2017-06-01 00:00:00

  • Off-label use of exenatide for the management of insulin-resistant type 1 diabetes mellitus in an obese patient with human immunodeficiency virus infection.

    abstract::Exenatide is an incretin mimetic indicated for the treatment of type 2 diabetes mellitus in combination with a sulfonylurea, a thiazolidinedione, metformin, or metformin plus a sulfonylurea or thiazolidinedione. Exenatide lowers postprandial blood glucose levels by stimulating glucose-dependent insulin secretion, inhi...

    journal_title:Pharmacotherapy

    pub_type: 杂志文章

    doi:10.1592/phco.27.10.1449

    authors: Sheffield CA,Kane MP,Busch RS

    更新日期:2007-10-01 00:00:00

  • Improving pharmacotherapy after myocardial infarction by group academic detailing using feedback data on a patient level.

    abstract:STUDY OBJECTIVE:To develop and evaluate a peer review group (PRG) meeting using feedback data on a patient level to improve the quality of drug therapy for prevention of recurrent myocardial infarction. DESIGN:Prospective follow-up study. DATA SOURCE:General practitioners' computerized patients records (intervention ...

    journal_title:Pharmacotherapy

    pub_type: 杂志文章

    doi:10.1592/phco.26.2.254

    authors: van der Elst ME,Bouvy ML,de Blaey CJ,de Boer A

    更新日期:2006-02-01 00:00:00

  • Effects of carbamazepine on cyclosporine metabolism in pediatric renal transplant recipients.

    abstract::This study documents a pharmacokinetic interaction between carbamazepine and cyclosporine (CsA) in pediatric renal transplant recipients. Noncompartmental steady-state CsA pharmacokinetics were determined in three pediatric renal transplant recipients who were receiving both CsA and carbamazepine as long-term therapy ...

    journal_title:Pharmacotherapy

    pub_type: 临床试验,杂志文章

    doi:

    authors: Cooney GF,Mochon M,Kaiser B,Dunn SP,Goldsmith B

    更新日期:1995-05-01 00:00:00

  • Nabilone for the Management of Pain.

    abstract::Nabilone, a synthetic cannabinoid, is approved in many countries including, but not limited to, Canada, the United States, Mexico, and the United Kingdom for the treatment of severe nausea and vomiting associated with chemotherapy. Clinical evidence is emerging for its use in managing pain conditions with different et...

    journal_title:Pharmacotherapy

    pub_type: 杂志文章,评审

    doi:10.1002/phar.1709

    authors: Tsang CC,Giudice MG

    更新日期:2016-03-01 00:00:00

  • Difficulties in anticoagulation management during coadministration of warfarin and rifampin.

    abstract::The clinical significance of rifampin's induction of warfarin metabolism is well documented, but no published studies or case reports have quantified this interaction with respect to the international normalized ratio (INR). A patient receiving concomitant rifampin and warfarin to treat a mycobacterial infection and i...

    journal_title:Pharmacotherapy

    pub_type: 杂志文章

    doi:10.1592/phco.21.15.1240.33897

    authors: Lee CR,Thrasher KA

    更新日期:2001-10-01 00:00:00

  • Comparing the bispectral index and suppression ratio with burst suppression of the electroencephalogram during pentobarbital infusions in adult intensive care patients.

    abstract:OBJECTIVE:The bispectral index (BIS), a processed variable derived from the raw electroencephalogram (EEG) used to guide sedation in the intensive care unit (ICU), has not been tested during barbiturate therapy for elevated intracranial pressure. We determined the BIS and suppression ratio (SR) values during traditiona...

    journal_title:Pharmacotherapy

    pub_type: 杂志文章

    doi:10.1592/phco.23.10.1087.32766

    authors: Riker RR,Fraser GL,Wilkins ML

    更新日期:2003-09-01 00:00:00

  • Time-dependent disposition of tacrolimus and its effect on endothelin-1 in liver allograft recipients.

    abstract:STUDY OBJECTIVE:To characterize a time-dependent disposition of oral tacrolimus and its relationship with plasma endothelin-1 concentrations. DESIGN:Randomized, crossover study. SETTING:Clinical research center of a university-affiliated hospital. PATIENTS:Twelve stable liver transplant recipients. INTERVENTIONS:In...

    journal_title:Pharmacotherapy

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:

    authors: Min DI,Chen HY,Lee MK,Ashton K,Martin MF

    更新日期:1997-05-01 00:00:00

  • Antimicrobial stewardship in patients with cancer.

    abstract::Consensus guidelines recommend antimicrobial stewardship in all hospitals with the following goals in mind: appropriate and judicious use of antimicrobial agents leading to increased drug safety, reduced antimicrobial utilization, reduction in the development and selection of resistant organisms, cost containment, and...

    journal_title:Pharmacotherapy

    pub_type: 杂志文章,评审

    doi:10.1002/j.1875-9114.2012.01162.x

    authors: Tverdek FP,Rolston KV,Chemaly RF

    更新日期:2012-08-01 00:00:00

  • Buspirone hydrochloride: a unique new anxiolytic agent. Pharmacokinetics, clinical pharmacology, abuse potential and clinical efficacy.

    abstract::Buspirone is the first of a new class of anxioselective agents, the azaspirodecanediones. It achieves peak serum concentrations within one hour and has a serum half-life of 2 to 5 hours. Animal studies have suggested antianxiety activity and the absence of abuse potential. Buspirone is both a dopamine agonist and anta...

    journal_title:Pharmacotherapy

    pub_type: 杂志文章,评审

    doi:10.1002/j.1875-9114.1984.tb03385.x

    authors: Goldberg HL

    更新日期:1984-11-01 00:00:00

  • Antimony excretion in a patient with renal impairment during meglumine antimoniate therapy.

    abstract::Meglumine antimoniate was administered to a patient with visceral leishmaniasis with normal renal function. Soon after the first intramuscular administration of meglumine antimoniate 20 mg/kg, equivalent to 510 mg antimony (Sb), the patient developed septic shock with oliguria. Creatinine clearance decreased to 23 ml/...

    journal_title:Pharmacotherapy

    pub_type: 杂志文章

    doi:10.1592/phco.20.13.1141.35032

    authors: Hantson P,Luyasu S,Haufroid V,Lambert M

    更新日期:2000-09-01 00:00:00

  • Cannabis for Chronic Pain: Challenges and Considerations.

    abstract::The National Academies of Sciences, Engineering, and Medicine has found substantial evidence that cannabis (plant) is effective for the treatment of chronic pain in adults, and moderate evidence that oromucosal cannabinoids (extracts, especially nabiximols) improve short-term sleep disturbances in chronic pain. The pa...

    journal_title:Pharmacotherapy

    pub_type: 杂志文章,评审

    doi:10.1002/phar.2115

    authors: Romero-Sandoval EA,Fincham JE,Kolano AL,Sharpe BN,Alvarado-Vázquez PA

    更新日期:2018-06-01 00:00:00

  • Peak antifactor xa activity produced by dalteparin treatment in patients with renal impairment compared with controls.

    abstract:STUDY OBJECTIVE:To evaluate the relationship between impaired renal function and antifactor Xa activity in patients receiving dalteparin. DESIGN:Open-label prospective study. SETTING:Inpatient and outpatient units of a large teaching hospital. SUBJECTS:Eleven patients with renal impairment and 11 control subjects wi...

    journal_title:Pharmacotherapy

    pub_type: 临床试验,杂志文章

    doi:10.1592/phco.2005.25.6.817

    authors: Shprecher AR,Cheng-Lai A,Madsen EM,Cohen HW,Sinnett MJ,Wong ST,Billett HH

    更新日期:2005-06-01 00:00:00

  • Effectiveness of pretreatment in decreasing adverse events associated with pamidronate in children and adolescents.

    abstract:STUDY OBJECTIVES:To assess the effectiveness of pretreatment with ibuprofen or acetaminophen compared with no pretreatment in decreasing adverse events in children and adolescents receiving the first and second series of pamidronate therapy; and to compare the effectiveness of ibuprofen versus acetaminophen for prevent...

    journal_title:Pharmacotherapy

    pub_type: 杂志文章

    doi:10.1592/phco.24.2.195.33143

    authors: Robinson RE,Nahata MC,Hayes JR,Batisky DL,Bates CM,Mahan JD

    更新日期:2004-02-01 00:00:00

  • Dissolution of struvite calculi by hemiacidrin solution.

    abstract::Struvite calculi result from urinary tract infections secondary to urease-producing bacteria. To prevent recurrent infection and stone formation complete removal of struvite calculi is recommended. Two illustrative reports of patients with renal struvite calculi are presented in which 10% hemiacidrin (Renacidin) irrig...

    journal_title:Pharmacotherapy

    pub_type: 杂志文章

    doi:10.1002/j.1875-9114.1983.tb03300.x

    authors: Massaro FJ,Weiner B,Sant GR,Meares EM Jr

    更新日期:1983-11-01 00:00:00

  • Benzocaine-induced methemoglobinemia in two patients: interdisciplinary collaboration, management, and near misses.

    abstract::Methemoglobin, a form of hemoglobin that does not bind oxygen, is produced when iron in red blood cells is oxidized from the ferrous state to the ferric state. Methemoglobinemia develops in the presence of oxidizing agents, such as benzocaine-containing topical anesthetic sprays, and it is characterized by cyanosis. I...

    journal_title:Pharmacotherapy

    pub_type: 杂志文章

    doi:10.1592/phco.27.8.1206

    authors: Throm MJ,Stevens MD,Hansen C

    更新日期:2007-08-01 00:00:00

  • Adjunctive aerosolized antibiotics for treatment of ventilator-associated pneumonia.

    abstract:STUDY OBJECTIVE:To determine clinical and microbiologic success in patients receiving adjunctive aerosolized antibiotics for the treatment of ventilator-associated pneumonia (VAP). DESIGN:Retrospective medical record review. SETTING:Level I trauma intensive care unit of a large academic medical center. PATIENTS:Fort...

    journal_title:Pharmacotherapy

    pub_type: 杂志文章

    doi:10.1592/phco.29.9.1054

    authors: Czosnowski QA,Wood GC,Magnotti LJ,Croce MA,Swanson JM,Boucher BA,Fabian TC

    更新日期:2009-09-01 00:00:00