Impact of an automated antibiotic time-out alert on the de-escalation of broad-spectrum antibiotics at a large community teaching hospital.

Broad-spectrum antibiotic de-escalation before and after implementation of a 72-hour antibiotic time-out alert within the electronic medical record was analyzed. De-escalation occurred significantly more often after the implementation of the alert (55.0% vs 35.1%; 95% confidence interval, -0.3491 to -0.0488; P < .01).

Identification of Factors Impacting Recurrent Clostridium difficile Infection and Development of a Risk Evaluation Tool.

PURPOSE: Recurrent Clostridium difficile infection (RCDI) is a growing concern, yet limited data exists to clarify which patients are at highest risk.  Identification of these patients may better inform decisions of those who may benefit from prophylactic intervention. The purpose of this study was to determine which factors are associated with the recurrence of Clostridium difficile infection (CDI) and to develop a risk stratification tool.  Methods. Patients readmitted within 10 weeks of positive C. difficile polymerase chain reaction (PCR) with symptoms were included in this retrospective case control study.  The primary outcome was analyzed via univariate regression analyses of the independent factors including age, gender, number of CDI episodes, administration of acid blocking agents, antibiotics or chemotherapy, Charlson Comorbidity Index, gastrointestinal conditions, and exposure to healthcare facilities.  Results. Recurrent CDI was identified in 44 of 220 included patients.  In the univariate analysis, factors associated with development of RCDI included antibiotic exposure (OR 2.51, 95% CI 1.14-5.54; p 0.02) and inflammatory bowel disease (OR 5.77, 95% CI 1.24-26.79; p 0.03).  An evaluation tool was created from a well-fit model.  Additional factors included in the tool were chosen based on evaluation of findings from existing literature.  Conclusions. Antibiotic therapy and inflammatory bowel disease were found to be associated with RCDI.  Although a statistically significant association with RCDI was not found for other factors, this is likely related to small sample size.  The creation of an evaluation tool using specific patient factors can help determine the risk of RCDI, while future studies may validate this tool. This article is open to POST-PUBLICATION REVIEW. Registered readers (see "For Readers") may comment by clicking on ABSTRACT on the issue's contents page.

Efficacy of Oral Vancomycin in Preventing Recurrent Clostridium difficile Infection in Patients Treated With Systemic Antimicrobial Agents.

We compared rates of recurrent Clostridium difficile infection in patients receiving or not receiving oral vancomycin prophylaxis with systemic antimicrobial therapy. The incidence of C. difficile infection was significantly lower in patients receiving prophylaxis (4.2% vs 26.6% in those without prophylaxis; odds ratio, 0.12; 95% confidence interval, .04-.4; P < .001).

Tularemia in a kidney transplant recipient: an unsuspected case and literature review.

Tularemia is a zoonotic infection that has rarely been reported in transplant recipients. The authors present a case of unsuspected tularemia in a kidney transplant patient that was diagnosed by isolation of Francisella tularensis in the blood. The patient was treated successfully with antibiotics. During diagnostic workup, a laboratory technician was exposed to tularemia by inhalation of the culture plate and received postexposure prophylaxis. This report emphasizes the importance of exposure history in the investigation of fever in an immunocompromised host and the special precautions needed when a virulent infectious organism is suspected.

Infectious complications in kidney transplant recipients: review of the literature.

Since the initial successful kidney transplantation in humans, the field of renal transplantation has made significant progress. Patient survival and graft survival have improved tremendously. Our armamentarium of immunosuppressive drugs and antimicrobial agents has expanded, as our understanding of their effects and proper utilization. Enhanced surgical techniques also improved the overall survival of kidney recipients. However, infectious complications remain a major cause of morbidity and mortality in this patient population. In this article, we provide an overview of infections in kidney transplant recipients, a detailed illustration of specific infectious agents with a focus on cytomegalovirus, and finally we lay some general principles for limiting the burden of infectious complications in kidney transplants through proper infection control measures.