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CIDRAP Stewardship/Resistance Scan - MDR infection risks study; C difficile pacemaker infection

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  • CIDRAP Stewardship/Resistance Scan - MDR infection risks study; C difficile pacemaker infection


    Stewardship / Resistance Scan for Oct 15, 2020
    MDR infection risks study; C difficile pacemaker infection
    Filed Under:
    Antimicrobial Stewardship; Clostridium difficile

    Study will examine risk factors for multidrug-resistant infections

    The University of Texas Health Science Center at Houston (UTHealth) announced yesterday that it has received an $11 million grant from the National Institute of Allergy and Infectious Diseases to conduct a 5-year study to better understand why some critically ill patients develop multidrug-resistant infections.
    Using state-of-the-art genomic analysis and microbiome analysis, researchers at UTHealth will seek to identify the microbial and clinical factors involved in infections caused by vancomycin-resistant enterococci, extended-spectrum beta-lactamase– and carbapenemase–producing Enterobacterales, and Clostridioides difficile. They'll follow study participants hospitalized in intensive care units at Memorial Hermann Hospital-Texas Medical Center, as well as those in the bone marrow transplant unit at the University of Texas MD Anderson Cancer Center, to understand why some patients colonized with these pathogens develop infections and others don't.
    "We want to learn more about how these three classes of organisms colonize the gastrointestinal tract of critically ill patients and, eventually, cause infections in these patient populations," Cesar Arias, MD, MSc, PhD, the study's principal investigator and professor of infectious disease at McGovern Medical School at UTHealth, said in a press release.
    Arias says the goals of the study will be to create an algorithm to determine whether patients have a low, medium, or high risk for these infections, and to develop future interventions based on that knowledge.
    Oct 14 UTHealth press release

    German researchers report C difficile pacemaker infection

    In a case study yesterday in Open Forum Infectious Diseases, German researchers reported what they say is the first documented case of a pacemaker infection caused by C difficile, a pathogen typically associated with intestinal infections.
    The case involved a 75-year-old man who underwent pacemaker implantation at a hospital in Munich following an acute ischemic stroke and treatment for aspiration pneumonia. No specific antibiotic prophylaxis was used for the procedure because the patient was still on antibiotics (piperacillin/tazobactam) for pneumonia. The patient was discharged to a rehabilitation facility 4 days after the procedure, then readmitted to the hospital 7 days later with fever and a reddened pacemaker incision site.
    Blood cultures and swab samples from the pacemaker, the leads connected to the device, and the pocket where the leads were implanted all came back positive for C difficile, as did stool samples tested to detect intestinal colonization. One toxigenic strain, RT014, was found in both the stool and the blood samples, but the patient showed no signs of gastrointestinal problems or diarrhea. Antibiotic treatment was switched to intravenous (IV) vancomycin and oral metronidazole, with oral antibiotic therapy switched to vancomycin after 3 days. After 42 days of IV and oral vancomycin, the pacemaker was reimplanted.
    Although the route of infection is unclear, the authors of the study suggest the C difficile bacteria could have been on the patient's skin or in the hospital environment. Given the high numbers of asymptomatic C difficile carriers and the growing use of implantable cardiac devices, they say they're surprised there haven't been more reports of extra-intestinal C difficile infections.
    "With rising numbers of implanted cardiac electronic devices and the high incidence of C. difficile infections and colonisations, bloodstream and device infections with C. difficile might be a potentially growing issue," they wrote. "Recommendations for management of extra-intestinal C. difficile infection risk and treatment are needed."
    C difficile is the leading cause of hospital-acquired diarrhea in the United States and Europe.
    Oct 14 Open Forum Infect Dis abstract