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Most Patients with C. difficile Infection Receive Unnecessary Antimicrobials

MONDAY, Jan. 21 (HealthDay News) -- The majority of patients with current or recent Clostridium difficile infection (CDI) receive unnecessary antimicrobials, with 26 percent receiving only unnecessary antimicrobials, according to research published in the February issue of Infection Control and Hospital Epidemiology.

In an effort to examine unnecessary antimicrobial use, Megan K. Shaughnessy, M.D., of the Minneapolis Veterans Affairs Health Care System, and colleagues performed a retrospective review of pharmacy and medical records for 246 patients diagnosed with new-onset CDI.

The researchers found that, during and/or after CDI treatment, 57 percent of patients with new-onset CDI received non-CDI antibiotics. More than three-quarters (77 percent) of all patients received at least one dose of unnecessary antimicrobials, and 26 percent received only unnecessary antimicrobials. Unnecessary antimicrobials were included in 45 percent of the total non-CDI antimicrobial days. The most commonly cited reasons for antimicrobial use included suspected pneumonia or urinary tract infection. Fluoroquinolones and β-lactam antibiotics were most often used.

"Non-CDI antimicrobials are often used unnecessarily in patients with a current or recent history of CDI," the authors write. "This suggests that, during this window of heightened risk of CDI recurrence, a large portion of non-CDI antimicrobial use could be avoided, thereby presumably mitigating some of the associated recurrence risk."

One author disclosed financial ties to the pharmaceutical industry.

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Further Reading
Duodenal infusions of donor feces are significantly more effective than vancomycin for treating recurrent Clostridium difficile infections, according to a study published online Jan. 16 in the New England Journal of Medicine.
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The total annual cost associated with the five major health care-associated infections is $9.8 billion, according to a meta-analysis published online Sept. 2 in JAMA Internal Medicine.
Although fecal microbial transplant is highly effective in treating recurrent C. difficile infection, a survey of infectious disease specialists shows that several barriers prevent the treatment from being available at most institutions.
Both restrictive and persuasive measures can be effective for changing antibiotic prescribing behavior in a hospital setting.
For men with urinary tract infection, longer duration of antibiotic treatment does not reduce recurrence; and treatment of preoperative bacteriuria has no clinical benefit, according to two studies published online Dec. 3 in the Archives of Internal Medicine.
Treatment with synthetic stool may produce better results and improve safety in patients with C. difficile infection that does not respond to standard therapy.
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