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Volume 6 Journal of Infectious Diseases and Therapy
ISSN: 2332-0877 Infection Congress 2018
March 01-02, 2018
March 01-02, 2018 Berlin, Germany
5th International Congress on
INFECTIOUS DISEASES
Antimicrobial Stewardship Program (ASP) eliminates Clostridium difficile infections in an oncology
hospital
Trisha Patel, Dean Miller and Mashiul Chowdhury
Eastern Regional Medical Center Cancer Treatment Centers of America, USA
Clostridium difficile is not only the most common organism to cause hospital acquired infections in the US but the incidence
in cancer patients is increasing significantly. Their risk factors for acquiring Clostridium difficile infections (CDI) are
prolonged hospitalization, chemotherapy, and changes in bowel environment. However, the most common risk is frequent
exposure to antibiotics. The centers for disease control and prevention showed the risk of CDI among those exposed to high-
risk antibiotics was three times higher compared to persons with low-risk or no antibiotic exposure. This emphasizes the
crucial role of ASPs which have created a positive impact on CDI rates in several studies. At a private oncology hospital, ASP
and infection control use several strategies to retain low rates of CDI. ASP reviews all patients on antibiotics daily to identify
opportunities to optimize therapy. Prospective audit and feedback is then provided to clinicians on any necessary interventions.
Educational in-services are also performed for nurses and the medical staff on a regular basis. Additionally, infection control
enforces strict hand hygiene for which compliance has consistently been greater than 98%. Due to oncology patients having
a higher incidence of baseline diarrhea, a three-component C. difficile test is used at this institution to reduce false positive
results. The glutamate dehydrogenase (GDH) antigen and enzyme immunoassay tests for toxins A and B are obtained on all
samples. If there is discordance between the tests, then only is a polymerase chain reaction (PCR) test performed. With these
combined efforts, there were 0 incidences of CDI over a period of 10 months in 2017 and no more than one incidence per
month since January of 2016. However, both incidences in August and September 2017 were false positive results. Therefore,
without any clinical infections, the institution had 0 incidences of CDI for one year (table 1).
References
1. Dubberke E R, Carling P, Carrico R, . (2014) Strategies to prevent Clostridium difficile infections in acute care
hospitals: 2014 Update. Infect Control Hosp Epidemiol 35(6):628-645.
2. Valiquette L, Cossette B, Garant M P, . (2007) Impact of a reduction in the use of high-risk antibiotics on the
course of an epidemic of Clostridium difficile-associated disease caused by the hyper-virulent NAP1/027 strain. CID
2007:45 (Suppl 2) S112-S121.
3. Muto C A, Blank M K, Marsh J W, . (2007) Control of an outbreak of an infection with the Hyper-virulent
Clostridium difficile BI strain in university hospital using a comprehensive bundle approach. CID 45:1266-1273.
4. Fowler S, Webber A, Cooper B S, . (2007) Successful use of feedback to improve antibiotic prescribing and reduce
Clostridium difficile infection: a controlled interrupted time series. Journal of Antimicrobial Chemotherapy 59:990-
995.
5. Carling P, Fung T, Killion A, Terrin N, (2003) Favorable impact of a multidisciplinary antibiotic management
program conducted during 7 years. Infection Control and Hospital Epidemiology 24(9):699-706.
Biography
Trisha Patel is the Infectious Diseases/Critical Care Pharmacist at Cancer Treatment Centers of America (CTCA). She completed her Pharmacy Residency with
a specialty in critical care at University of Alabama Hospital in Birmingham (UAB). After working at UAB for four years as the Medical ICU Pharmacist, she moved
to Philadelphia to work at CTCA. Since acquiring this position, she has assisted Dr. Mashiul Chowdhury in managing all patients on antibiotics as well as to lead
their Antimicrobial Stewardship Program.
Trisha Patel et al., J Infect Dis Ther 2018, Volume 6
DOI: 10.4172/2332-0877-C1-039