343. Clostridium difficile Associated Diarrhea Incidence and Outcomes for Patients Treated with Intravenous Antibiotics in Infectious Disease (ID) Physician Office Infusion Centers (POICs)
Session: Poster Abstract Session: Clostridium difficile - Epidemiology, Diagnosis, Treatment, and Prevention
Friday, October 21, 2011
Room: Poster Hall B1
  • IDSA_2011_Poster_343_Nathan_C_diff.pdf (395.9 kB)
  • Background: Patients (pts) receiving intravenous antibiotic (IVAB) therapy are considered at risk for acquiring C. difficile infection (CDI). Pts receiving IVAB at an infectious disease (ID) physician office infusion center (POIC) may spend less time in a health care facility thus potentially reducing the risk of serious health care facility-associated (HCFA) CDI.  The study purpose was to evaluate the incidence of CDI for pts receiving IVAB at ID POICs.

    Methods: A retrospective database review was conducted of pts in 7 ID POICs nationally treated with selected IVAB from Jan 1st, 2010 through June 30th, 2010.  Selected IVAB included all carbapenems, cephalosporins, fluoroquinolones, monobactams, and penicillins. Pts were identified with confirmed or suspected CDI. Data collection included demographics, comorbidities, oral antibiotic (AB) use, and treatment (tx) of CDI.  Clinical outcomes were measured in cases of confirmed CDI.

    Results:  We reviewed 934 patients who received IVAB from the aforementioned list.  29 pts (3.1%) were identified as either confirmed (8, <1%) or suspected (21, 2%).  7 confirmed cases met criteria for community-associated CDI and 1 confirmed case met criteria for community-onset, HCFA CDI.  Incidence of CDI was estimated at 2.5 per 10,000 days.  Mean age was 70.  Pts received an average of 2 AB over a mean duration of 28 days (11-52).  This included tx with both IVAB and po AB.  The most causative IVAB was ceftriaxone (2) and the most causative oral AB agent was ciprofloxacin (2).  Risk factors included diabetes (5) and immunocompromise (2).  3 pts were taking concomitant acid-suppressive medications.  6 confirmed pts were treated for CDI with single agent metronidazole (MTZ) and 1 with dual agents including MTZ and vancomycin.  Additionally, 8 suspected CDI pts were treated with MTZ.  Confirmed CDI was cured in 5/8 pts and improving in 2/8 at discharge.  One tx failure occurred in the pt with HCFA CDI.

    Conclusion: Pts receiving broad-spectrum IVAB at ID POICs had a very low rate of CDI.  This study further validates the safety in treating patients, when clinically appropriate, through an ID POIC.  Additional studies are warranted to demonstrate differences in outcomes between pts treated in ID POICs versus other healthcare settings. 


    Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

    Ramesh V. Nathan, MD, Mazur, Statner, Dutta, Nathan, PC, Thousand Oaks, CA, Jorge R. Bernett, MD, Infectious Disease Doctors Medical Group, Walnut Creek, CA, Andrew H. Krinsky, MD, Infectious Diseases Associates, Sarasota, FL and Lucinda J. Van Anglen, PharmD, Healix Infusion Therapy, Inc., Sugar Land, TX


    R. V. Nathan, Healix: Contract Management Services, Contract Management Services

    J. R. Bernett, Cubist: Speaker's Bureau, Speaker honorarium
    Pfizer: Speaker's Bureau, Speaker honorarium
    Healix: Contract management svcs, Contract managment svcs

    A. H. Krinsky, Healix: Contract Management Services, Contract Management Services

    L. J. Van Anglen, Astellas: Scientific Advisor, Consulting fee
    Healix: Employee, Salary

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.