Disclosure

•  Thestudywithlargersamplesizeiswarrantedinordertoconfirmthisfinding.

•  Combina:onofLactobacillusstrainsprobio:chasthepoten:altoreduceAADandhospitallengthofstayinhospitalizedadultpa:ents.

•  Sincethep-valueforprimaryoutcomeis0.884,thereisnosignificantreduc:onintherateofCDIusingLactobacillusstrainsprobio:c.

•  Forsecondaryoutcomes,AADrateissignificantlylessintheprobio:cgroupasp-value=0.021andhospitallengthofstayisalsoshorter.

•  Limita:onsincludesinglecenterandretrospec:vestudy,extensiveexclusioncriteria,inclusionofonlyhospitalist’spa:ents,andpoten:alconfoundingfactors.

Piperacillin/tazobactam

20% Ampicillin/sulbactam

2%

CePriaxone29%

Levofloxacin30%

Cefepime8%

Ciprofloxacin3%

Meropenem5%

Imipenem0% Clindamycin

3%

CePazidime0%

Piperacillin/tazobactam

19%Ampicillin/sulbactam

4%

CePriaxone16%

Levofloxacin17%

Cefepime18%

Ciprofloxacin9%

Meropenem9%

Imipenem0%

Clindamycin8%

CePazidime0%

Effectofapharmacist-drivenmanagementprotocolontheprobio9ccombina9onofLactobacillusstrainsforpreven9onofClostridiumdifficile

infec9on(CDI)inhospitalizedadultpa9entsUyenHuynh,Pharm.D.1.2,GregoryK.Perry,Pharm.D.,BCPS-AQID,BCIDP2,YoungR.Lee,Pharm.D.,BCPS,BCCCP1,PetePalmere,Pharm.D.Candidate1.2

1TexasTechUniversityHealthSciencesCenterSchoolofPharmacy,Abilene,Texas,2HendrickMedicalCenter,Abilene,Texas

Background Results

Conclusion

•  Theauthorsofthisstudydonothaveanyconflictsofinterest.

Pre-implementa9on

•  In2011,anes:mateof435,000caseswithCDIwasreportedand29,000deathsoccurredastheresultofthedisease.

•  ThefinancialburdenofU.S.healthcarerela:ngtoCDIwasimmense,cos:ngabout$4.8billion.

•  Probio:chasbeenamajordebateinliteraturewhetheritshouldberecommendedforprimarypreven:onofCDI.

•  ThestrainthatwasfoundtohavethemostprominentdatainreducingCDIrateisLactobacilluscaseiaccordingtoameta-analysis.

•  Lactobacillusacidophilus,Lactobacilluscasei,andLactobacillusrhamnosushavebeenusedinconjunc:ontostandardprotec:vemeasuresatacommunityhospitalintheQuebecregiontoreducetheincidenceofCDI.

1)  Lessaetal.TheNewEnglandJournalofMedicine.2015,372;9;825-34.2)  Caietal.UEGJournal2018,6(2),169-180.3)  Maziade,P.;Pereira,P.;Goldstein,E.Clin.Infect.Dis.2015,60(Suppl.2),

S144–S147.

References

Purpose•  Todetermineifapharmacist-drivenprotocolusing

combina:onstrainsofLactobacillusacidophilus,Lactobacilluscasei,andLactobacillusrhamnosuswouldhelptoreducetheincidenceofCDI

MethodsStudydesign•  Single-center,observa:onal,retrospec:vecohortpre-post

studyDatacollec:onperiod•  Pre-implementa:ondata:OctobertoFebruary2017•  Post-implementa:ondata:OctobertoFebruary2018Inclusioncriteria•  Hospitalist’spa:ent•  Pa:entswhoreceivedprobio:cswithin48hoursof

administra:onofthefollowingan:bio:cs:Piperacillin/tazobactam,ampicillin/sulbactam,cePriaxone,levofloxacin,cefepime,ciprofloxacin,meropenem,imipenem,clindamycin,andcePazidime

Pharmacist-drivenprotocolapprovedbyPharmacy&Therapeu:csandPerformanceImprovementcommikeewasimplementedtoautoma:callystartprobio:cifpa:entmeetscriteriaandhasnoexclusion

Table1.Baselinecharacteris9csCharacteris9cs Pre-

implementa9on(n=218)

Post-implementa9on

(n=239)Age(meaninyears) 60.0 61.7Weight(meaninkg) 85.7 88.2

BMI(%)•  <18.5kg/m2

•  18.5–24.9kg/m2•  25–29.9kg/m2•  ≥30kg/m2

5.123.930.740.0

5.428.925.540.2

Gender(%)•  Male•  Female

50.949.1

56.943.1

PriorhistoryofCDI(n) 6 8NumberofpreviousCDI(n) 10 9Hospitaliza:onorlong-termcarefacilitywithin90days(%) 28.0 28.9Dura:onofan:bio:cs(meanindays) 6.9 5.51Indica:onsofan:bio:cduringhospitaliza:on(%)•  Boneandjointinfec:ons•  Cardiovascularinfec:ons•  Centralnervoussysteminfec:ons•  Intra-abdominalinfec:ons•  SkinandsoP:ssueinfec:ons•  Upperandlowerrespiratorytractinfec:ons•  Urinarytractinfec:ons

2.33.70.922.521.630.723.9

5.90.81.38.422.645.623.0

Acid-suppressiontherapy(AST)duringhospitaliza:on(%) 64.7 49.4Laxa:ve(s)usedduringhospitaliza:on(%) 53.7 47.7Narco:c(s)usedduringhospitaliza:on(%) 79.4 63.2

Post-implementa9on

Figure1.PrescribedAn9bio9csTable2.Outcomes

1o&2oOutcomesandSafetyresults Pre-implementa9on

(n=218)

Post-implementa9on

(n=239)PrimaryoutcomesIncidenceofCDIduringhospitaliza:on(n,%)•  Mildtomoderate(n,%)•  Severe(n,%)•  Severe,complicated(n,%)

6(2.75)3(1.38)2(0.92)1(0.46)

6(2.51)2(0.84)4(1.67)0(0.0)

Secondaryoutcomes•  An:bio:c-associateddiarrhea(AAD)during

hospitaliza:on(n,%)•  Hospitallengthofstay(meanindays)

36(15.5)

8.52

22(9.21)

6.62

Safety•  Lactobacillusbacteremia(n,%)

0(0.0)

0(0.0)

Discussion

n=218 n=239