The impact of toxigenic culture on antimicrobial prescriptions for Clostridioides difficile infection: The role of diagnostic stewardship.

• 資料種別: 博士論文
• タイトル: The impact of toxigenic culture on antimicrobial prescriptions for Clostridioides difficile infection: The role of diagnostic stewardship.
• 著者・編者: Sang-Tae, Lee; Tanaka, Shinobu; Yamazaki, Masaharu; Inoue, Takashi; Kasahara, Kei
• 著者標目: Sang-Tae, Lee; Tanaka, Shinobu; Yamazaki, Masaharu; Inoue, Takashi; Kasahara, Kei
• 出版事項: 奈良医学会
• 出版年月日等: 2021-11-30
• 出版年（W3CDTF）: 2021-11-30
• 並列タイトル等: 毒素培養がClostridioides difficile感染症の抗菌薬処方に与える影響 : diagnostic stewardshipの役割
• タイトル（掲載誌）: Journal of Nara Medical Association
• 巻号年月日等（掲載誌）: 72 4,5,6
• 掲載巻: 72
• 掲載号: 4,5,6
• 掲載ページ: 43-50
• ISSN（掲載誌）: ISSN : 1345-0069
• 授与機関名: 奈良県立医科大学
• 授与年月日: 2022-03-15
• 報告番号: 乙第1525号
• 学位: 博士（医学）
• 本文の言語コード: eng
• 件名標目: Clostridioides difficile infection (CDI); toxigenic culture; diagnostic stewardship
• 対象利用者: 一般
• 一般注記: type:Thesis; Introduction : Toxigenic culture has been recommended as a sensitivity enhancement option for testing Clostridioides difficile infections (CDI). However, no studies have evaluated whether toxigenic culture impacts clinical decisions such as CDI treatment. Methods : At Nara Medical University Hospital, simultaneous testing of glutamate dehydrogenase antigen (A) and toxin A/B (T) by immunochromatography has been conducted since November 2013. Furthermore, toxigenic culture (C) has been adopted since April 2018. Therefore, patients tested for CD were divided into two groups: pre-period from April 2014 to March 2018 and post-period from April 2018 to March 2021. Patient data were retrospectively examined. Results : The study included 1262 and 1023 cases in the pre- and post-periods, respectively. A significant reduction in A+T+ cases could be observed with 64 (5.1 %) and 28 (2.7%) in the pre- and post-periods (P = 0.005), respectively. Of the 104 A+T- cases undergoing toxigenic culture in the post-period, 54 (51.9 %) were A+T-C+. The antimicrobial administration ratio for the A+T-C+ cases (68.5 %) was lower than that for the A+T+ patients (90.6 and 82.1 %, P = 0.014 and P = 0.417, in the pre- and post-periods, respectively), and was not significantly different from that of the A+T-patients (64.2 and 64.1 % in the pre- and post-periods, respectively) or from that of the A+ T-C-patients (64 %). Conclusion : This study showed that toxigenic culture does not necessarily affect the antibiotic administration ratio or duration. A coordinated approach under diagnostic stewardship for improved reporting and interpretation of toxigenic cultures would be necessary.; 博士（医学）・乙第1525号・令和4年3月15日; identifier:Journal of Nara Medical Association Vol.72 No.4,5,6 p.43-50 (2021.11); identifier:13450069; identifier:http://ginmu.naramed-u.ac.jp/dspace/handle/10564/4030; identifier:Journal of Nara Medical Association, 72(4,5,6): 43-50
• オンライン閲覧公開範囲: インターネット公開
• 連携機関・データベース: 国立情報学研究所 : 学術機関リポジトリデータベース（IRDB）（機関リポジトリ）; https://irdb.nii.ac.jp
• 提供元機関・データベース: 奈良県立医科大学 : 奈良県立医科大学機関リポジトリ GINMU

目次

http://ginmu.naramed-u.ac.jp/dspace/bitstream/10564/4030/1/01%e4%b9%991525%e6%9c%ac%e6%96%87%e3%81%ae%e8%a6%81%e6%97%a8.pdf fulltext

http://ginmu.naramed-u.ac.jp/dspace/bitstream/10564/4030/2/02%e4%b9%991525%e5%af%a9%e6%9f%bb%e8%a6%81%e6%97%a8.pdf fulltext

http://ginmu.naramed-u.ac.jp/dspace/bitstream/10564/4030/3/03%e4%b9%991525%e6%9c%ac%e6%96%87.pdf fulltext