Implementation of Global Strategies to Prevent Hospital-Onset <i>Clostridium difficile</i> Infection: Targeting Proton Pump Inhibitors and Probiotics

Lewis, Paul O.; Lundberg, Timothy S; Tharp, Jennifer L.; Runnels, Clay W

doi:10.1177/1060028017694050

Cited by 11 publications

(16 citation statements)

References 27 publications

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“…In a study reported by Lewis et al, multifaceted strategies aimed at preventing Clostridium difficile colitis succeeded in decreasing PPI use. After one year of such a program, the overall number of PPI prescriptions decreased by 14% 20 . Taken together with that reported herein, these results suggest that achieving a sustainable reduction of the prescribed quantities of both oral and IV PPIs requires sustained interventions.…”

Section: Resultssupporting

confidence: 77%

Curbing proton pump inhibitor overprescribing: Multifaceted strategies in an academic hospital

2021

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What is known and objective Proton pump inhibitors (PPI) have become essential in the management of upper gastrointestinal disorders, yet they are prescribed without an indication in up to 89% of cases and the number of prescribed PPIs is on the rise. A working group developed several multifaceted strategies in our multihospital trust to curb inappropriate PPI use. We describe herein these strategies and assess their impact on PPI consumption in a hospital belonging to this trust. Methods From 2012 to 2019, our actions included the publication and presentation of a review of emergent PPI side effects, the development of an appropriate use leaflet, medication audits, journal club meetings, and prescription analysis. We considered that a decrease in PPI consumption could be a relevant surrogate criterion for the appropriation and acceptance of these interventions; this was assessed from 2012 to 2019 and expressed as defined daily dose (DDD)/1000 patient‐days. Results and discussion There was a clear downward trend in the consumption of PPIs, both in medical and surgical wards. The overall PPI use decreased by 17.1% (from 566 to 468 DDD/1000 patient‐days). IV PPI consumption dropped by 37.7% (from 146 to 91 DDD/1000 patient‐days), while oral PPIs consumption decreased by 10% (from 420 to 378 DDD/1000 patient‐days). What is new and conclusion Sustained strategies aimed at curbing PPI overprescribing led to a sustained decrease in PPI consumption in our hospital. This decrease encourages us to pursue this strategy and to diversify our actions.

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Section: Resultssupporting

confidence: 77%

Curbing proton pump inhibitor overprescribing: Multifaceted strategies in an academic hospital

2021

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“…Although decreases in HO-CDI can be obtained through improving antibiotic use and optimizing the hygiene practices, [14][15][16] the impact of ASP interventions aimed at reducing inappropriate NAAT is beginning to emerge. Kociolek 21 utilized a similar clinical decision support tool and demonstrated decreased inappropriate testing and avoidance of testing among patients with concomitant laxative use.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic stewardship of C. difficile testing: a quasi-experimental antimicrobial stewardship study

Christensen

Barr

Martin

et al. 2019

Infect. Control Hosp. Epidemiol.

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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.

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“…One of the major risk factors for H. pylori infection is the long-term use of proton pump inhibitors (PPI), which are also regarded as a notable risk factor for CDI. Taking this into account, Lewis et al conducted a retrospective cohort study that targeted proton pump inhibitor use and probiotics and concluded that decreasing PPI use and increasing probiotic use decreases the risk of hospital-acquired CDI [19].…”

Section: Reviewmentioning

confidence: 99%

Probiotics and Clostridium Difficile: A Review of Dysbiosis and the Rehabilitation of Gut Microbiota

Kalakuntla¹,

Nalakonda²,

Nalakonda³

et al. 2019

Cureus

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The basis of this paper is to address the use of probiotics as a novel approach to help treat the growing problem of antibiotic-associated diarrhea (AAD), particularly, Clostridium difficile-associated diarrhea (CDAD). Most of the available data regarding probiotics and their usefulness in treating Clostridium difficile infection (CDI) was collected and analyzed. Studies showed the effectiveness of probiotics in treating and also preventing CDI, as well as other gastrointestinal conditions such as Helicobacter pylori infection and inflammatory bowel disease. Probiotics also have, based on limited research, a comparatively minimal adverse effect profile and can aid in faster recovery from disease. Extensive research has been done on two organisms, Lactobacillus and Saccharomyces, but further research into other effective organisms are needed. More clinical trials also need to be conducted to better understand the side effect profile, optimal dosage, drug interactions, and long-term effects on gut microbiota.

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Implementation of Global Strategies to Prevent Hospital-Onset Clostridium difficile Infection: Targeting Proton Pump Inhibitors and Probiotics

Cited by 11 publications

References 27 publications

Curbing proton pump inhibitor overprescribing: Multifaceted strategies in an academic hospital

Curbing proton pump inhibitor overprescribing: Multifaceted strategies in an academic hospital

Diagnostic stewardship of C. difficile testing: a quasi-experimental antimicrobial stewardship study

Probiotics and Clostridium Difficile: A Review of Dysbiosis and the Rehabilitation of Gut Microbiota

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