Decreasing Clostridium difficile infections by an antimicrobial stewardship program that reduces moxifloxacin use.

Clostridium difficile infections (CDI) in hospitalized patients are known to be closely related to antibiotic exposure. Although several substances can cause CDI, the risk differs between individual agents. In Vienna and other eastern parts of Austria, CDI ribotype 027 is currently highly prevalent. This ribotype has the characteristic of intrinsic moxifloxacin resistance. Therefore, we hypothesized that moxifloxacin restriction can decrease the number of CDI cases in hospitalized patients. Our antibiotic stewardship (ABS) group applied an information campaign on CDI and formal restriction of moxifloxacin in Wilhelminenspital (Vienna, Austria), a 1,000- bed tertiary care hospital. The preintervention period (period 1) was January through May 2013, and the intervention period (period 2) was June through December 2013. We recorded the defined daily doses (DDD) of moxifloxacin and the number of CDI patients/month. Moxifloxacin use was reduced from a mean (±standard error of the mean [SEM]) of 1,038±109 DDD per month (period 1) to 42±10 DDD per month (period 2) (P=0.0045). Total antibiotic use was not affected. The mean (±SEM) numbers of CDI cases in period 1 were 59±3 per month and in period 2 were 32±3 per month (46% reduction; P=0.0044). Reducing moxifloxacin use in combination with providing structured information on CDI was associated with an immediate decrease in CDI rates in this large community teaching hospital.

Epidemiology of patients hospitalised for pneumonia in 2011: a prospective multicentre cohort study.

This study was conducted to investigate the age dependent epidemiology of pneumonia and risk factors for mortality.The data were derived from the Austrian Pneumonia Network (APNET), comprising nine Departments for Internal Medicine with a total of 1,011 hospital beds. All inpatients diagnosed with pneumonia during 2011 were followed until discharge. Identification of microorganisms was performed according to local standard methods. Data of patients < 65 years and ≥ 65 years were compared by Mann-Whitney and the Chi-square tests. Risk factors for hospital mortality were evaluated by univariate and multivariate analyses.Overall, 1,956 patients were included. The hospital mortality was 10.4 %, and was higher in patients ≥ 65 (12.7 %) than in patients < 65 years of age (5.0 %; p < 0.001). Streptococcus (S.) pneumoniae was the most important pathogen. Enterobacteriacaeae were revealed significantly more often in patients ≥ 65 years. Age ≥ 65 years, chronic heart failure (CHF) and neurological disease increased the risk of hospital mortality 1.96 (95 % CI 1.19-3.20), 1.59 (95 % CI 1.10-2.29), and 1.7 (95 % CI 1.19-2.41)-fold, respectively.In conclusion, pneumonia patients with CHF, neurological disease and age ≥ 65 years could benefit from intensified care due to increased risk of in-hospital death.

Pharmacokinetics of intraperitoneal and intravenous fosfomycin in automated peritoneal dialysis patients without peritonitis.

Blood and dialysate concentrations of fosfomycin were determined after intravenous and intraperitoneal application of 4 mg/liter in patients undergoing automated peritoneal dialysis. Maximum serum concentrations after intravenous (287.75 ± 86.34 mg/liter) and intraperitoneal (205.78 ± 66.78 mg/liter) administration were comparable. Ratios of intraperitoneal to systemic exposure were 1.12 (intraperitoneal administration) and 0.22 (intravenous administration), indicating good systemic exposure after intraperitoneal application but limited penetration of fosfomycin into the peritoneal fluid after the intravenous dose.