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28 ANTIBIOTIC RESISTANCE & STEWARDSHIP Study: Antibiotics Important Risk Factor for Community- Associated C. Diff in Adults By Anuja Vaidya A study published in Open Forum Infectious Diseases examined risk factors for community-associated Clostridium difficile infection in adults. Researchers performed a case-control study with participants from 10 U.S. sites from October 2014 to March 2015. Researchers defined case patients as those older than 18 years, with a positive C. diff specimen collected as an outpatient or within three days of hospitalization. Study participants were not admitted to a healthcare facility in the prior 12 weeks prior to the infection and had no prior C. diff diagnosis. Researchers matched each case patient to one control, a person without C. diff diagnosis. Of 226 pairs, researchers found more case patients had prior outpatient healthcare and antibiotic exposures compared to controls. e study highlighted the following risk factors for community-associ- ated C. diff infection: • Antibiotic exposure, including cephalosporin, clindamycin and fluoroquinolone • Emergency department visit • White race • Cardiac disease • Chronic kidney disease • Inflammatory bowel disease n Antibiotic Stewardship Program Reduces Deaths From Candidemia, Multidrug- Resistant Bloodstream Infections By Anuja Vaidya A study published in Clinical Infectious Diseases examined the effect of an educational antimicro- bial stewardship program on hospital-acquired candidemia and multidrug-resistant bloodstream infec- tions. Researchers conducted a quasi-experimental interven- tion study with an interrupted time-series analysis. The study examined a multifaceted educational intervention at a tertiary care hospital over a five-year period. The intervention included peer-to-peer educational in- terviews between counselors and antibiotic prescribers from all departments. A quick and intense reduction in antibiotic consumption occurred six months after the implementation of the intervention. The reduction was sustained over the next few years. Additionally, the intervention resulted in a decreasing trend in incidence density of candidemia and multi- drug-resistant bloodstream infections. It also reduced mortality rate. n Computer Alerts Can Lower Antibiotic Prescriptions for Sinusitis, Study Shows By Anuja Vaidya R esearchers from Oakland, Calif.-based Kaiser Per- manente's Southern California Department of Re- search & Evaluation found computer alerts helped reduce the odds of physicians prescribing an antibiotic for sinusitis. They published their findings in the Ameri- can Journal of Managed Care. The Kaiser Permanente research team used a pragmat- ic stepped-wedge cluster randomized study design. From September 2014 through April 2015, researchers tracked nearly 22,000 initial acute sinusitis encounters in adults at primary and urgent care offices. They studied the effect of a computer-based interven- tion on antibiotic prescription patterns. The intervention included computer alerts to inform doctors when antibi- otics may not be the best course of treatment. Clinical decision support was associated with a 22 per- cent decrease of antibiotic use post-intervention, but the absolute reduction was only 2 percent. Additionally, researchers found provider education had a large effect initially, but was not sustained over the study period. n