Predicting the Risk of
            <i>Clostridium difficile</i>
            Infection upon Admission: A Score to Identify Patients for Antimicrobial Stewardship Efforts

Kuntz, Jennifer L; Smith, David H.; Petrik, Amanda F.; Yang, Xiuhai; Thorp, Micah L.; Barton, T L; Barton, Karen; Labreche, Matthew J.; Spindel, Steven J.; Johnson, Eric S.

doi:10.7812/tpp/15-049

Cited by 25 publications

(19 citation statements)

References 28 publications

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“…39,40 Given the major consequences of rCDI on patient outcomes, our results support the need to expand research on the prevention and treatment of recurrence. Such research may also result in the identification of novel predictors that are currently unavailable even in the most comprehensive EMRs.…”

Section: Discussionsupporting

confidence: 60%

Prediction of RecurrentClostridium DifficileInfection Using Comprehensive Electronic Medical Records in an Integrated Healthcare Delivery System

Escobar

Baker

Kipnis

et al. 2017

Infect. Control Hosp. Epidemiol.

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BACKGROUND Predicting recurrent Clostridium difficile infection (rCDI) remains difficult. METHODS. We employed a retrospective cohort design. Granular electronic medical record (EMR) data had been collected from patients hospitalized at 21 Kaiser Permanente Northern California hospitals. The derivation dataset (2007–2013) included data from 9,386 patients who experienced incident CDI (iCDI) and 1,311 who experienced their first CDI recurrences (rCDI). The validation dataset (2014) included data from 1,865 patients who experienced incident CDI and 144 who experienced rCDI. Using multiple techniques, including machine learning, we evaluated more than 150 potential predictors. Our final analyses evaluated 3 models with varying degrees of complexity and 1 previously published model. RESULTS Despite having a large multicenter cohort and access to granular EMR data (eg, vital signs, and laboratory test results), none of the models discriminated well (c statistics, 0.591–0.605), had good calibration, or had good explanatory power. CONCLUSIONS Our ability to predict rCDI remains limited. Given currently available EMR technology, improvements in prediction will require incorporating new variables because currently available data elements lack adequate explanatory power.

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Section: Discussionsupporting

confidence: 60%

Prediction of RecurrentClostridium DifficileInfection Using Comprehensive Electronic Medical Records in an Integrated Healthcare Delivery System

Escobar

Baker

Kipnis

et al. 2017

Infect. Control Hosp. Epidemiol.

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“…The study had only trend analysis and document-type features and included no information on bibliometric components, such as countries, authors, and institutions. [ 10 ] Şenel et al . reported a bibliometric study on Behçet literature during the period of 1980–2014 by using WoS database and they found that Turkey which had the highest reported prevalence of Behçet disease ranked first in the literature with both publication number and productivity score (25.14) followed by Tunisia, Israel, and Greece (21.03, 17.04, and 12.02, respectively).…”

Section: Discussionmentioning

confidence: 99%

The depigmented literature: A holistic analysis of global vitiligo publications between 1975 and 2017

Şenel

2020

Indian J Dermatol

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Background: Vitiligo is a common depigmenting disorder with a prevalence of 0.5–2%. Despite the increasing popularity of bibliometric studies in recent years, medical literature lacks a report investigating bibliometric features of vitiligo literature. Aim: It was aimed to analyze vitiligo literature by evaluating productivity of countries, institutions, and authors, and performing assessment of publication trends, bibliometric networks, and correlations. Material and Methods: We collected all data in this study by searching databases provided by Web of Science. All documents published on vitiligo literature between 1975 and 2017 were included. We performed correlation analyses between productivity and demographical and economical features of the countries publishing vitiligo articles. Results: A total of 7187 documents were detected and 72.2% of which was original article. The peak year for publication number by year was 2016 with 528 articles and the highest number of citations was reported in 2017. The USA was the leading country by total publication number (24.82%) followed by the United Kingdom (UK), India, China, and Italy (10.91%, 8.64%, 7.54%, and 6.87% respectively). Estonia was found to be the most productive country of vitiligo literature (13.01) followed by Netherlands, the UK, and Switzerland (12.64, 11.78, and 9.25, respectively). We found a high correlation between GDP per capita and the productivity of the countries ( r = 0.732, P < 0.001). Conclusion: As revealed in our study, although vitiligo occurs worldwide, developed countries dominated vitiligo literature. Researchers from developing and least-developed countries should be encouraged and supported to perform novel vitiligo studies.

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“…4 The broad spectrum β-lactam antibiotics, such as penicillins and cephalosporins, are particularly disruptive as their use significantly reduces certain families of bacteria, including obligate anaerobes, which are considered an essential component of a healthy gut ecosystem. 5,6 Antibiotics are a major cause of gut microbiome disruption, and broad-spectrum antimicrobials are strongly associated with an increased risk for CDI 4,7,8 including clindamycin, fluoroquinolones and β-lactam antibiotics (penicillins, cephalosporins and carbapenems). 4,5,[9][10][11][12] All intravenous (IV) β-lactam antibiotics are at least partially processed in the liver and excreted through the bile into the intestine as active antimicrobials.…”

Section: Introductionmentioning

confidence: 99%

<p>Ribaxamase, an Orally Administered β-Lactamase, Diminishes Changes to Acquired Antimicrobial Resistance of the Gut Resistome in Patients Treated with Ceftriaxone</p>

Kokai‐Kun

Trout

et al. 2020

IDR

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Introduction: Intravenous (IV) β-lactam antibiotics, excreted through bile into the gastrointestinal (GI) tract, may disrupt the gut microbiome by eliminating the colonization resistance from beneficial bacteria. This increases the risk for Clostridium difficile infection (CDI) and can promote antimicrobial resistance by selecting resistant organisms and eliminating competition by non-resistant organisms. Ribaxamase is an orally administered β-lactamase for use with IV βlactam antibiotics (penicillins and cephalosporins) and is intended to degrade excess antibiotics in the upper GI before they can disrupt the gut microbiome and alter the resistome. Methods: Longitudinal fecal samples (349) were collected from patients who participated in a previous Phase 2b clinical study with ribaxamase for prevention of CDI. In that previous study, patients were treated with ceftriaxone for a lower respiratory tract infection and received concurrent ribaxamase or placebo. Extracted fecal DNA from the samples was subjected to whole-genome shotgun sequencing and analyzed for the presence of antimicrobial resistance (AMR) genes by alignment of sequences against the Comprehensive Antibiotic Resistance Database. A qPCR assay was also used to confirm some of the results. Results: Database alignment identified~1300 acquired AMR genes and gene variants, including those encoding β-lactamases and vancomycin resistance which were significantly increased in placebo vs ribaxamase-treated patients following antibiotic exposure. qPCR corroborated the presence of these genes and supported both new acquisition and expansion of existing gene pools based on no detectable copy number or a low copy number in preantibiotic samples which increased post-antibiotics. Additional statistical analyses demonstrated significant correlations between changes in the gut resistome and clinical study parameters including study drug assignment and β-lactamase and vancomycin resistance gene frequency. Discussion: These findings demonstrated that ribaxamase reduced changes to the gut resistome subsequent to ceftriaxone administration and may help limit the emergence of AMR.

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Predicting the Risk of Clostridium difficile Infection upon Admission: A Score to Identify Patients for Antimicrobial Stewardship Efforts

Cited by 25 publications

References 28 publications

Prediction of RecurrentClostridium DifficileInfection Using Comprehensive Electronic Medical Records in an Integrated Healthcare Delivery System

Prediction of RecurrentClostridium DifficileInfection Using Comprehensive Electronic Medical Records in an Integrated Healthcare Delivery System

The depigmented literature: A holistic analysis of global vitiligo publications between 1975 and 2017

<p>Ribaxamase, an Orally Administered β-Lactamase, Diminishes Changes to Acquired Antimicrobial Resistance of the Gut Resistome in Patients Treated with Ceftriaxone</p>

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