Announcements

SAVE THE DATE – DOCTORS’ DAY CELEBRATION – MARCH 30, 2020

Posted on Feb 4, 2020 in Announcements | 0 comments

Alta Bates Summit’s Comprehensive Cancer Center Receives National Accreditation

Posted on Feb 4, 2020 in Announcements | 0 comments

CMS Ratings Are Officially Out – Both Summit and Alta Bates Campuses Receive 5 Stars!

Posted on Feb 4, 2020 in Announcements | 0 comments

*EPINEPHRINE DOSING ALERT* Treatment of Anaphylaxis

Posted on Jan 6, 2020 in Announcements | 0 comments

Wellbeing Committee News

Posted on Dec 2, 2019 in Announcements | 0 comments

The Summit campus Peer Support Program is turning one year old this month. We reached out to about 25 people – that’s 2 a month. We don’t keep data other than the date of contact, but we were able to, by memory, reach out to most of those we contacted and 80% said they felt at least a little better after talking to us.  90% thought the program added to the sense of community of the med center. 

The program works best when we can pair people with those is similar specialties.  Emily Abe learned how to do lead a support conversation earlier this month so now we have a surgeon on our team! Thanks, Emily!

We will help Eden, Alta Bates and SEBMG start programs in the coming year. Which will potentially help those of us who work in those setting. 

Thanks to all involved – especially JillKC for her leadership.   Please contact me with questions or comments!

Leif Hass

Potential benefits of probiotics and proton pump inhibitor (PPI) minimization on hospital-acquired Clostridium Difficile infection

Posted on Dec 2, 2019 in Announcements | 0 comments

Normal gut flora is thought to prevent Clostridium Difficile (C.diff) colonization and disease. Antibiotics causes a disruption in this gut flora, making patients more vulnerable to C.diff disease and recurrences. The 2018 Infectious Disease Society of America (IDSA)/Society for Healthcare Epidemiology of America (SHEA) guidelines recommends oral vancomycin or fidaxomicin for first-line therapy of initial Cdiff disease. Oral metronidazole is no longer recommended as first-line therapy for initial episodes given its lower clinical response rate. 

The use of probiotics may decrease the risk of developing C.diff infections in those patients taking antibiotics by replenishing some of the natural gut microflora that may have been lost. Current guidelines do not make a recommendation either for or against probiotics use, although some evidence exists that supports its use.

A 2017 Cochrane review article based on 31 randomized trials (8672 patients) with moderate evidence suggested that the risk of C.Diff-associated diarrhea (CDAD) is reduced by 60% when probiotics are used. A post-hoc analysis, however, demonstrated that probiotics were effective among trials with a high baseline CDAD risk (>5%) but not in trials with a baseline risk ≤ 5%.

Short-term use of probiotics appeared to be safe and effective in patients who were not immunocompromised or severely debilitated. Although further research is needed, the benefits and harms of probiotics can be evaluated on a case-by-case basis.

Proton Pump Inhibitors (PPI) such as pantoprazole have been associated with increased occurrence of CDAD by decreasing gastric acid production and allowing C.diff to proliferate in the host. In a 2017 systematic review article by Trifan A. et al, a significant association between C.diff infections and PPI use was found. The IDSA guidelines currently has no recommendations on the use of PPIs, although they recommend discontinuing unnecessary PPI usage. If the following indications are not present, discontinuation of PPIs should be considered: coagulopathy, >48 hours of mechanical ventilation, GI ulcer/bleeding, PUD, GERD, or chronic NSAID use.

References:

  • Johnston, Brad C, and Kristian Thorlund. “Probiotics for the Prevention of Clostridium Difficile Associated Diarrhea in Adults and Children.” Cochrane Database of Systematic Reviews, 2009, doi:10.1002/14651858.cd006095.pub2.
  • Mcdonald, L Clifford, et al. “Clinical Practice Guidelines for Clostridium Difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA).” Clinical Infectious Diseases, vol. 66, no. 7, 2018, pp. 987–994., doi:10.1093/cid/ciy149.
  • Trifan, Anca, et al. “Proton Pump Inhibitors Therapy and Risk of Clostridium Difficile Infection: Systematic Review and Meta-Analysis.” World Journal of Gastroenterology, vol. 23, no. 35, 2017, pp. 6500–6515., doi:10.3748/wjg.v23.i35.6500.