Drug Topics - December 12, 2008 - (Page H6)

HSE I Clinical INFECTIOUS DISEASE Deaths from C. dif cile increasing KATHRYN FOXHALL esearch is providing hints about rate fell from 1.4 to 0.8 the possible relationship between cases per 1,000 patient Clostridium difficile and various medi- days. The decrease was cations, according to studies recently associated with reducpresented in Washington, D.C., at the tion in the consumption annual joint meeting of the American of ticarcillin/clavulanate, Society for Microbiology and the Infec- gatiﬂoxacin/levoﬂoxacin, and clindamycin. tious Disease Society of America. According to another C. difﬁcile is one of the few conditions presently causing an increased number paper presented at the of deaths over time; it may contribute to Washington meeting, as many as 20,000 deaths per year, ac- narcotic use may be incording to the Centers for Disease Con- creasing the severity of some C. difﬁcile cases. Re- Some of the research was based on patient records trol and Prevention (CDC). University of Iowa researchers re- searchers looked at the from St. Luke’s Episcopal Hospital in Houston. ported that seasonal peaks in C. difﬁcile records of 21,240 patients occur mostly in March, following in- at St. Luke’s Episcopal Hospital in Hous- Administration Connecticut Health Care ﬂuenza peaks in December, January, ton, of whom 123 developed C. difﬁcile System. They cautioned that some patients suspected of having C. difﬁcile may and February. They note, “We believe infection. They found that 49.3 percent of pa- actually have norovirus, even if there that this relationship exists because of tients who did not get C. is no outbreak of that disease. Tests of the increased antibiotic use difficile had been treated stool samples of 73 patients suspected during inﬂuenza seasons.” with narcotics and about of having C. difﬁcile showed that 9 had Philip Polgreen and 51.2 percent of those who that disease, but 13 had norovirus and colleagues used data from POWER POINTS did get the disease had not 51 had neither. The researchers noted 1998 to 2005 from the C. dif cile may received narcotics. The that despite the advent of molecular asHealthcare Cost and Utilizacontribute to gaps were much wider be- says for norovirus, testing for it is still tion Project, Nationwide In20,000 deaths tween patients with severe relatively uncommon. patient Sample to pinpoint annually. Also at the meeting, research from C. difﬁcile and those whose the time relationship. the Canadian Nosocomial Surveilcases were refractory. Christine Hansen and Narcotic use may The researchers, led by lance System Program, which can co-authors said that inciincrease severity of some cases. A. L. Mora, found that of C. offer some studies not available in dence of C. difﬁcile fell dradifﬁcile patients who had not the United States, conﬁrmed that sematically with the institubeen given narcotics, 40.4 vere C. difﬁcile cases are more likely tion of an antimicrobial stewardship effort. In 2004 and 2005, percent had severe cases; of those who to be associated with the emerging the Shands facility at the University of had received narcotics, 61.5 percent had NAP1/027/BI strain (known as NAP1) Florida put use restrictions on a num- severe cases. In addition, the research- and are more likely to occur in the ber of antibiotics. During their four-year ers said, 20 percent of C. difﬁcile patients elderly. Of 1,008 C. difficile patients study, the consumption of ceftriaxone, who had received narcotics had refractory studied, 31 percent were infected with ticarcillin/clavulanate, ciprofloxacin, cases, deﬁned as persistent diarrhea after the NAP1 strain. Clifford McDonald, gatiﬂoxacin/levoﬂoxacin, and clindamy- seven days of treatment. Among the C. MD, a C. difﬁcile expert from the CDC, cin signiﬁcantly decreased. The C. difﬁcile difﬁcile patients who did not receive nar- indicated that the epidemic is still incotics, only 10 percent of the cases were creasing, as far as can be determined refractory. Researchers also found that use from hospital discharge data through Network SEE INDEX PAGE 8 of narcotics appeared to increase the dura- 2006. There are no regular reportClinical tion of time between admission and the ing requirements for C. difficile. For more info on this topic, see www.drugtopics.com diagnosis of C. difﬁcile. Another clue was offered by re- KATHRYN FOXHALL is a healthcare searchers associated with the Veterans journalist in the Washington, D.C., area. R H6 DRUG TOPICS D E C . 15, 2008 W W W.D R U GTO P I C S .C O M COURTESY ST. LUKE’S EPISCOPAL HOSPITAL IN HOUSTON http://WWW.DRUGTOPICS.COM http://WWW.DRUGTOPICS.COM

Table of Contents Feed for the Digital Edition of Drug Topics - December 12, 2008

Drug Topics - December 12, 2008 Contents Up Front Up Front In Depth Letters Health-System Edition Cover Story: Controlled Substance Disposal a Growing Problem for Hospitals Pharmacists Hope for Speedy Approvals Deaths from C. Difficile Increasing PharmMD Teams with HealthSpring RX Care Commentary Ohio Hospital Automates Pharmacy The Business Outlook for 2009 OTC The Pharmacist's Duty to Warn: Implications for Pharmacy Practice New Products Viewpoint

Drug Topics - December 12, 2008

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