A Multipronged Approach to Decrease the Risk of Clostridium difficile Infection at a Community Hospital and Long-Term Care Facility

Journal of Clinical Outcomes Management. 2015 September;SEPTEMBER 2015, VOL. 22, NO. 9:

September 2, 2015|Journal of Clinical Outcomes Management

Bridget Olson, RPh;Ronald A. Floyd, PharmD, MS;John Howard, PharmD;Tarek Hassanein, MD;Kenneth Warm, MD;Roger Oen, MD, MPH

Probiotics

During 2009–2011, only 15% of the CDI patients had received probiotics with an antibiotic course. Probiotic therapy as part of CDI treatment increased from 60% in 2009 to 91% in 2011. Among patients that contracted CDI in 2012–2013, only 2 patients received probiotics with their antibiotic courses.

Recurrences

In 2009, the recurrence rate was 64%, with the rate decreasing dramatically over the study period (Figure 8). The time frame for inclusion of a recurrent CDI event was 0–180 days. It is likely the events occurring from 91 to 180 days later may have been new events; however, all were included as recurrent events in our study (Figure 9). In reviewing acid suppression of the recurring CDI patients, 70% were on PPI, 20% on H2RA, and 10% had no acid reduction.

With regard to the effect of probiotics within this population, those who received

probiotics in the later time period were significantly less likely to have a recurrence (chi square = 8.75, df = 1, P = 0.003). The OR was 0.26 (95% CI 0.10 to 0.65). More specifically, for all episodes of CDI, patients who received probiotics with their initial CDI treatment were significantly less likely to have a recurrence (OR 0.35; 95% CI 0.14 to 0.87).

One patient with significant initial antibiotic pressure was continued on her PPI during CDI treatment and continued to have recurrences, despite probiotic use. After her fourth recurrence, her PPI was changed to an H2RA, and she had no further recurrences. She continues off PPI therapy and is CDI-free 2 years later. Another patient who remained on his PPI had 3 recurrences, until finally a probiotic was added and the recurrences abated.

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