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