C andida auris is an emerging, multidrug-resistant, healthcare-associated fungal pathogen that was first reported in Japan in 2009 and has now been isolated on 6 continents (1-9). C. auris has been identified as the causative pathogen in various invasive fungal infections, including bloodstream infections (2,4), and is associated with outbreaks across healthcare settings (6,10). Risk factors for C. auris infection are similar to other Candida infections including prolonged hospitalization, abdominal surgery, diabetes mellitus, intensive care unit (ICU) admission, use of central venous and urinary catheters, immunocompromising conditions, chronic kidney disease, and exposure to broad-spectrum antibiotic and antifungal agents (10-13). Investigations in the Chicago, Illinois, USA, area have found a high prevalence of C. auris colonization at ventilator-capable skilled nursing facilities (14) and have shown higher rates of C. auris colonization among patients who are mechanically ventilated, have a gastrostomy tube, or have a urinary catheter (15). Reported mortality rates attributable to invasive C. auris infection range from 30% to 59% globally (13,16) and from 22% to 57% in the United States (8,10,17). C. auris isolates are often resistant to fluconazole and have variable susceptibility to other antifungal agents (13,16). The Centers for Disease Control and Prevention (CDC) currently recommends echinocandins as empiric therapy for suspected or confirmed C. auris infections (18). However, recent reports have indicated reduced susceptibilities to echinocandins and suggest that resistance might be inducible under antifungal pressure (8,16). Previous reports of C. auris infections and outbreaks have largely focused on epidemiologic information, and data on treatment strategies and clinical outcomes are limited (6,8,10,16-21). We report microbiologic data for C. auris isolates from a multisite health system in Illinois and an assessment of clinical outcomes for patients treated for C. auris infections. Methods This study is a retrospective cohort analysis of patients at 8 hospitals within a single health system located in the Chicago metropolitan area. We included all patients >18 years old who had >1 positive culture for C. auris from any anatomic site during January 1,
Fluoroquinolones (FQs) are often preferred as oral step-down therapy for bloodstream infections (BSIs) due to favorable pharmacokinetic parameters; however, they are also associated with serious adverse events. The objective of this study was to compare clinical outcomes for patients who received an oral FQ versus an oral beta-lactam (BL) as step-down therapy for uncomplicated streptococcal BSIs. This multi-center, retrospective cohort study analyzed adult patients who completed therapy with an oral FQ or BL with at least one blood culture positive for a Streptococcus species from January 1, 2014 to June 30, 2019. The primary outcome was clinical success, defined as lack of all-cause mortality, recurrent BSI with the same organism, and infection-related readmission at 90 days. A multivariable logistic regression model for predictors of clinical failure was conducted. A total of 220 patients were included, with 87 (40%) receiving a FQ and 133 (60%) receiving a BL. Step-down therapy with an oral BL was non-inferior to an oral FQ (93.2% vs. 92.0%; mean difference 1.2%, 90% CI -5.2 to 7.8). No differences were seen in 90-day mortality, 90-day recurrent BSI, 90-day infection-related readmission, or 90-day incidence of C. difficile-associated diarrhea. Predictors of clinical failure included: oral step-down transition before day three (OR = 5.18, 95% CI 1.21, 22.16) and low dose oral-step down therapy (OR = 2.74, 95% CI 0.95, 7.90). Our results suggest that oral step-down therapy for uncomplicated streptococcal BSI with a BL is non-inferior to a FQ.
Objective: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 (Pstep = .06; Ptrend = .008) and SIR (Pstep = .1; Ptrend = .017) trends concurrent with decreases in oral vancomycin (Pstep < .001; Ptrend < .001). HO-CDI-IR within a noninterventional control unit did not change (Pstep = .125; Ptrend = .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.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.