trimethoprim--sulfamethoxazole-drug-combination and Enterocolitis--Pseudomembranous

We introduced a long-term care facility (LTCF) infectious disease (ID) consultation service (LID service) that provides on-site consultations to residents of a Veterans Affairs (VA) LTCF. We determined the impact of the LID service on antimicrobial use and Clostridium difficile infections at the LTCF.. A 160-bed VA LTCF.. Systemic antimicrobial use and positive C. difficile tests at the LTCF were compared for the 36 months before and the 18 months after the initiation of the ID consultation service through segmented regression analysis of an interrupted time series.. Relative to that in the preintervention period, total systemic antibiotic administration decreased by 30% (P<.001), with significant reductions in both oral (32%; P<.001) and intravenous (25%; P=.008) agents. The greatest reductions were seen for tetracyclines (64%; P<.001), clindamycin (61%; P<.001), sulfamethoxazole/trimethoprim (38%; P<.001), fluoroquinolones (38%; P<.001), and β-lactam/β-lactamase inhibitor combinations (28%; P<.001). The rate of positive C. difficile tests at the LTCF declined in the postintervention period relative to preintervention rates (P=.04).. Implementation of an LTCF ID service led to a significant reduction in total antimicrobial use. Bringing providers with ID expertise to the LTCF represents a new and effective means to achieve antimicrobial stewardship.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; beta-Lactams; Ciprofloxacin; Clindamycin; Clostridioides difficile; Enterocolitis, Pseudomembranous; Humans; Infectious Disease Medicine; Long-Term Care; Nitrofurantoin; Nursing Homes; Referral and Consultation; Regression Analysis; Tetracyclines; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

In a comparative study of infection prophylaxis, patients with acute leukemia receiving remission induction therapy were assigned either no prophylaxis, sulfamethoxazole and trimethoprim, ketoconazole, or the combination of sulfamethoxazole and trimethoprim and ketoconazole. Both sulfamethoxazole and trimethoprim and the combination of sulfamethoxazole and trimethoprim and ketoconazole substantially reduced the overall incidence of infection consequent to a marked decrease in bacterial infection. However, sulfamethoxazole and trimethoprim were associated with an increased rate of fungal infection, while ketoconazole decreased this complication. No form of prophylaxis reduced infectious mortality or increased the complete remission rate. However, because of its effect in reducing infectious morbidity, we conclude that patients with acute leukemia receiving remission induction treatment should be given antibacterial and antifungal prophylaxis.

Topics: Acute Disease; Adolescent; Adult; Aged; Bacterial Infections; Drug Combinations; Drug Therapy, Combination; Enterocolitis, Pseudomembranous; Humans; Ketoconazole; Leukemia; Middle Aged; Mycoses; Pneumonia; Sepsis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Recent meta-analyses showed that antibiotic prophylaxis in patients with neutropenia after chemotherapy reduced the incidence of fever and mortality rate. Fluoroquinolones appear to be most effective and well tolerated. Thus, in April 2008, we changed our antibiotic prophylaxis regimen from cotrimoxazole/colistin (COT/COL) to the fluoroquinolone ciprofloxacin (CIP) in patients with acute myeloid leukemia (AML). The aim of this retrospective study was to compare efficacy and development of bacterial resistance with two different prophylaxis regimens over a time period of more than 4 years.. Induction chemotherapy courses given for AML during the antibiotic prophylaxis period with COT/COL (01/2006-04/2008) and CIP (04/2008-06/2010) were retrospectively analyzed with a standard questionnaire.. Eighty-five courses in the COT/COL group and 105 in the CIP group were analyzed. The incidence of fever was not significantly different (COT/COL 80 % vs CIP 77 %; p = 0.724). Also, the rate of microbiologically documented infections was nearly the same (29 vs 26 %; p = 0.625). In addition, there was no significant difference in the incidence of clinically documented infections (11 vs 19 %; p = 0.155) or in the rates of detected gram-positive and gram-negative bacteria. Of note, there was no increase in resistance rates or cases with Clostridium difficile-associated diarrhea in the CIP group.. The antibiotic prophylaxis with CIP compared to COT/COL in AML was similarly effective with no increase in bacterial resistance. COT/COL may have the advantages of providing additional prophylaxis against Pneumocystis jirovecii pneumonia and leaving fluoroquinolones as an additional option for treatment of febrile neutropenia.

Topics: Adult; Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Antineoplastic Agents; Bacterial Infections; Ciprofloxacin; Clostridioides difficile; Colistin; Diarrhea; Drug Resistance, Bacterial; Enterocolitis, Pseudomembranous; Female; Fever; Fluoroquinolones; Humans; Incidence; Leukemia, Myeloid, Acute; Male; Middle Aged; Neutropenia; Pneumocystis carinii; Pneumonia, Pneumocystis; Retrospective Studies; Surveys and Questionnaires; Trimethoprim, Sulfamethoxazole Drug Combination

We reviewed hospital records of women on the obstetrics and gynecologic services with a diagnosis of antibiotic-associated diarrhea, pseudomembranous colitis, or Clostridium difficile infection to better characterize the incidence and course of women with C difficile infection. Cases were included if there was identification of C difficile by culture or toxin or endoscopic verification of pseudomembranous colitis. Between January 1985 and June 1995, there were 74,120 admissions to the obstetrics and gynecology services at two tertiary level hospitals. Eighteen women were found to have documented C difficile infection (0.02%)--3 from the obstetric services, 10 from the benign gynecologic services, and 5 from the gynecologic/oncology services. Diarrhea developed from 2 days to 30 days after antibiotics had been given (mean, 10 days). Nine patients had fever, six had nausea and vomiting, and five had abdominal pain. Antimicrobial agents given before infection included cephalexin, cefoxitin, imipenem, ciprofloxacin, trimethoprim/sulfamethoxazole, ampicillin, gentamicin, and clindamycin. All patients were treated successfully with inpatient antimicrobial agents-15 with metronidazole and 3 with vancomycin. There was one possible recurrence.

Topics: Abdominal Pain; Adult; Aged; Aged, 80 and over; Ampicillin; Anti-Bacterial Agents; Bacterial Toxins; Cefoxitin; Cephalexin; Cephalosporins; Cephamycins; Ciprofloxacin; Clindamycin; Clostridioides difficile; Colonoscopy; Diarrhea; Enterocolitis, Pseudomembranous; Female; Fever; Gentamicins; Humans; Imipenem; Incidence; Middle Aged; Nausea; Penicillins; Pregnancy; Pregnancy Complications, Infectious; Retrospective Studies; Thienamycins; Trimethoprim, Sulfamethoxazole Drug Combination; Vomiting

Topics: Adult; AIDS-Related Opportunistic Infections; Clostridioides difficile; Enterocolitis, Pseudomembranous; Humans; Male; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination

To determine the period prevalence of Clostridium difficile disease and asymptomatic carriage in the residents of long-term care facilities (LTCF) and to characterize the risk factors for colonization or associated disease.. Period prevalence survey.. Two long-term care facilities in St. Paul, MN.. Specimens were collected from 225 LTCF residents.. The dependent variable was the culture result for C. difficile, which was isolated and identified using selective culture media and a commercial anaerobe identification kit. Tissue culture assay was used to detect the ability of each C. difficile isolate to produce toxin. Independent variables (including gender, age, race, current medical diagnoses, severity of underlying disease, case mix, current clinical symptoms, current medications, antibiotic use within 4 weeks prior to specimen procurement, and other pertinent history) were obtained from the current medical record of each participant.. Of 225 stool cultures that were obtained, 16 (7.1%) were positive for C. difficile. None of the residents with a positive culture was symptomatic. History of nosocomial infection and the use of antibiotics in general, cephalosporins, trimethoprim/sulfamethoxazole (TMP/SMX), and histamine-2 blockers were significantly associated with positive C. difficile culture (P < or = 0.05) by univariate analyses. Trends towards significance (0.05 < 0.10) were noted for narcotic use, previous hospitalization, LTCF, and non-insulin-dependent diabetes mellitus. Logistic regression analysis revealed significant, independent predictors of positive culture: antibiotic use in general (P = 0.028; relative risk = 3.31), histamine-2 antagonist use (P = 0.038; relative risk = 3.27), cephalosporin use (P = 0.038; relative risk = 4.66), and TMP/SMX use (P = 0.007; relative risk = 8.45).. The use of antibiotics, particularly cephalosporins and TMP/SMX, is a significant risk factor for asymptomatic carriage of C. difficile in long-term care facilities. The use of H-2 blockers was also a significant risk factor for carriage; however, this finding has not been reported previously and should be confirmed by independent studies. These medications should be used judiciously in the LTCF population. When diarrheal diseases are encountered in LTCF residents, a high index of suspicion for C. difficile infection should be maintained and the appropriate diagnostic and therapeutic measures taken.

Topics: Aged; Aged, 80 and over; Carrier State; Cephalosporins; Clostridioides difficile; Cross Infection; Diabetes Mellitus, Type 2; Diagnosis-Related Groups; Enterocolitis, Pseudomembranous; Environmental Monitoring; Epidemiological Monitoring; Feces; Female; Health Surveys; Histamine H2 Antagonists; Hospitalization; Humans; Infection Control; Logistic Models; Male; Narcotics; Prevalence; Risk Factors; Severity of Illness Index; Skilled Nursing Facilities; Trimethoprim, Sulfamethoxazole Drug Combination

We describe the occurrence of antibiotic-associated pseudomembranous colitis in two cases of Henoch Schonlein purpura. We discuss the potential diagnostic difficulties and suggest that Henoch Schonlein purpura may predispose to the development of antibiotic-associated pseudomembranous colitis.

Topics: Cephradine; Child; Drug Combinations; Enterocolitis, Pseudomembranous; Humans; IgA Vasculitis; Male; Metronidazole; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Constipation; Drug Combinations; Enterocolitis, Pseudomembranous; Female; Humans; Middle Aged; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Antibiotic-associated colitis (pseudomembranous colitis) developed in four patients with spinal cord injury and taking oral trimethoprim-sulfamethoxazole. One hundred forty-eight (59%) of 251 patients with spinal cord injury who were evaluated had received this drug. Two of the four patients with pseudomembranous colitis did not promptly respond to therapy, and all four suffered significant further immobilization because of the disease. Pseudomembranous colitis readily occurs in at least certain population groups receiving trimethoprim-sulfamethoxazole.

Topics: Adult; Anti-Infective Agents, Urinary; Clostridium Infections; Diarrhea; Drug Combinations; Enterocolitis, Pseudomembranous; Humans; Male; Middle Aged; Premedication; Spinal Cord Injuries; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

A 94-year-old man had pseudomembranous colitis while taking low dose trimethoprim-sulfamethoxazole for recurrent urinary tract infection. The suppressive effect of low dose trimethoprim-sulfamethoxazole on normal colonic flora appeared to be a factor in the development of pseudomembranous colitis in this patient.

Topics: Aged; Anti-Infective Agents, Urinary; Drug Combinations; Enterocolitis, Pseudomembranous; Humans; Male; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Child, Preschool; Drug Combinations; Enterocolitis, Pseudomembranous; Female; Humans; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Drug Combinations; Enterocolitis, Pseudomembranous; Humans; Male; Radiography; Salmonella Food Poisoning; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Although acute renal failure secondary to infections is relatively common in adult patients, uremia requiring dialysis has not previously been reported in an adult patient with shigella enterocolitis. Our patient, infected with S flexneri, had severe renal failure without any evidence of sepsis, rhabdomyolysis, or the hemolytic-uremic syndrome. Antibiotic therapy with trimethoprim-sulfamethoxazole appeared to play a role in his eventual recovery.

Topics: Acute Kidney Injury; Adult; Drug Combinations; Dysentery, Bacillary; Enterocolitis, Pseudomembranous; Humans; Male; Peritoneal Dialysis; Shigella flexneri; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Aged; Anti-Bacterial Agents; Drug Combinations; Drug Therapy, Combination; Enterocolitis, Pseudomembranous; Female; Humans; Loperamide; Male; Metronidazole; Middle Aged; Neomycin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin