China
Africa
Explore chapters and articles related to this topic
Better System Performance
Published in Paul Batalden, Tina Foster, Sustainably Improving Health Care, 2022
Mark E. Splaine, Jeremiah R. Brown, Craig N. Melin, Rosalind A. Lasky, Tina Foster, Paul Batalden
Hospital-acquired Clostridium difficile infection remains a significant cause of morbidity and mortality.12,13 There are many patient and system factors that contribute to C. difficile infection. The patient factors include advanced age, exposure to antibiotics, and immunosuppression. The system factors most commonly associated with C. difficile infection are insufficient hand hygiene, insufficient environmental cleanliness, and poor antibiotic stewardship.
Advancements in Research on Necrotizing Enterocolitis Pathogenesis and Prevention Using PIGS
Published in David J. Hackam, Necrotizing Enterocolitis, 2021
Douglas Burrin, Juan Marini, Murali Premkumar, Barbara Stoll, Per Torp Sangild
In addition to therapeutic approaches using defined probiotic preparations, there has been a rapid emergence of fecal microbiome transfer (FMT) that has been widely used to demonstrate the sufficiency of the microbiota to transfer the phenotype of a donor to the recipient host (124, 154). This approach has become a standard of care in the treatment of recurrent Clostridium difficile infection in humans (155). The use of FMT has recently emerged as an approach to protect against NEC and modify the gut microbiome in mice, rats, and preterm pigs (156–159). Interestingly, the study in preterm pigs showed that rectal FMT administration may be a safer and more tolerable than the oral route in the preterm host where innate immunity and intestinal barrier function are poorly developed (156). These early studies using FMT in neonates raise several important questions as to the source and amount of donor fecal sample as well as the route (oral, orogastric tube feeds, rectal) and frequency of administration.
Ulcerative colitis and indeterminate colitis in children
Published in Alejandra Vilanova-Sánchez, Marc A. Levitt, Pediatric Colorectal and Pelvic Reconstructive Surgery, 2020
Alessandra C. Gasior, Ross Maltz
Ulcerative colitis (UC) is a chronic inflammatory condition that is limited to the colon. The endoscopic findings include friable mucosa with the loss of vascular pattern continually from the rectum extending proximally. Ulcerative colitis in the pediatric population tends to have a more severe disease course than in the adult population. Patients may present with acute severe colitis (ASC) and require inpatient hospitalization. However, a subset of patients may be refractory to medical management and may require surgical intervention. Approximately 29% of adults and up to 33% of children may not respond to medical management and will require surgical management of their disease [1]. Patients with poor prognostic factors include deep ulcerations on endoscopy, metabolic alkalosis, and gaseous distension of the small bowel. Patients should also have stool samples sent to rule out Clostridium difficile infection as well as colonic biopsies to evaluate CMV colitis.
Fecal calprotectin as a biomarker of intestinal inflammation in ICU patients with diarrhea – testing the pipette method against the collection pin and weighing methods
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2022
Karoline Hardis, Sarah B. Johansen, Janne Eriksen, Kjeld Damgaard, Peter Derek Christian Leutscher, Soren Jepsen
It was possible to extract fecal test material from all the liquid stool samples using both the collection pin and the pipette method. In addition, calprotectin was measured in all the stool samples (Table 2). Calprotectin values by the collection pin method ranged from 12 mg/kg to 941 mg/kg versus 28 mg/kg to 2729 mg/kg by the pipette method. All five patients presented with a lower calprotectin value using the collection pin compared to the pipette method. On average the collection pin measured 45% lower than the pipette method with a 95% confidence interval (30 − 59%). In patient A, C, D and E both the collection pin and the pipette method presented calprotectin values above the threshold of 160 mg/kg strongly indicating presence of intestinal inflammation. One (A) of the four patients was diagnosed with Clostridium difficile infection (Table 1), whereas none of the other were identified with any intestinal pathogens or IBD as another potential cause of intestinal inflammation.
Long-term prescribing of nitrofurantoin for urinary tract infections (UTI) in veterans with spinal cord injury (SCI)
Published in The Journal of Spinal Cord Medicine, 2019
Alexander B. Chew, Katie J. Suda, Ursula C. Patel, Margaret A. Fitzpatrick, Swetha Ramanathan, Stephen P. Burns, Charlesnika T. Evans
Nearly all patients who use indwelling bladder drainage devices will have bacterial colonization of the bladder (bacteriuria).11 Bacteriuria is also prevalent in patients with neurogenic bladder. In the absence of signs or symptoms indicating infection, antimicrobial treatment of bacteriuria in patients with neurogenic bladder is not routinely recommended.11 Despite this, inappropriate antimicrobial treatment of bacteriuria is common. This is particularly an issue in long-term care and contributes to the problem of bacterial resistance, antibiotic-associated adverse events, and Clostridium difficile infection.6–7,12 However, distinguishing between bacteriuria and UTI in patients with SCI can be difficult because these patients may not exhibit classic UTI symptoms of dysuria, urinary urgency/frequency, and pelvic pain.6,11
Investigational drug therapies currently in early-stage clinical development for the treatment of clostridioides (clostridium) difficile infection
Published in Expert Opinion on Investigational Drugs, 2019
Mai-Chi N. Tran, Ravina Kullar, Ellie J. C. Goldstein
Clostridioides (Clostridium) difficile Infection (CDI) is a major cause of healthcare-associated diarrheal infection, an immediate and urgent global healthcare threat and a reportable disease to National Health Safety Network (NHSN) [1] and is an element in the value-based purchasing initiative. The Centers for Medicare and Medicaid Services (CMS) introduced Hospital Inpatient Value-Based Purchasing program, which are quality performance–based adjustments of up to 1% to Medicare reimbursements for acute care hospitals [2]. As part of this value-based purchasing initiative, CMS reduces payment for patients diagnosed with selected hospital-acquired infections such as C. difficile [3,4]. Over the past 15 years, there has been a 237% increase in CDI-related hospitalizations [5]. Primary (15–40%) and secondary (15–30%) CDI recurrence is not infrequent including a 31% risk in patients >65 years old [6], 33% risk in immunocompromised hosts and a twofold increased risk in patients with renal disease [7]. These recurrences lead to an increased re-admission in 28.3% of patients (75.2% vs. 46.9% CDI infected vs. non-infected, respectively) [8]. The increased 30-day mortality has risen to 36.3% vs. 25.7% (p < 0.004) [9]. CDI has added approximately $4.5 billion in extra medical care costs and patients have a 55% increased length of stay. In 2017, CDI became a quality indicator and hospitals can be penalized for both readmissions and as a quality measure.