Tanya Ravipati

Background: Recent European Society of Clinical Microbiology and Infection and Australasian Society of Infectious Diseases Clostridioides difficile infection (CDI) management guidelines endorse the addition of intravenous tigecycline in patients who are progressing to fulminant infection. However, there are very limited data regarding clinical outcomes with this approach. Aims: We aimed to evaluate mortality and adverse outcomes after tigecycline combination therapy was commenced at the time of fulminant CDI. Methods: This retrospective single‐site observational study included patients between January 2018 and December 2022 treated with adjunctive intravenous tigecycline for fulminant CDI in addition to oral vancomycin and intravenous metronidazole. The primary outcome was all‐cause mortality at 30 days. Secondary outcomes included clinical cure, partial response, in‐hospital CDI‐attributable and 90‐day all‐cause mortality, colectomy and adverse events. Results: Eighteen patient episodes occurred, with median age 67.5 years, requiring intensive care admission and inotropic support in 66.7% and 50% of episodes respectively. All‐cause mortality at 30 days was 22.2%. Clinical cure occurred at 14 days in 16.7% of cases and partial response requiring further oral therapy in 55.6%. There was one colectomy and two serious adverse events, including a hyperkalaemic cardiac arrest in a haemodialysis patient and one significant intra‐abdominal bleeding episode requiring surgery. Conclusions: Tigecycline combination therapy resulted in improved all‐cause 30‐day mortality in high‐risk CDI patients versus historical data, without the use of faecal microbiota transplantation. Poor outcomes were seen in three patients with pre‐existing renal failure, and we question the efficacy and safety of tigecycline in this group. This is a useful salvage strategy, but monitoring for toxicity is essential.

Background: Hospital electronic health record (EHR) systems contain extensive data of varying quality and suitability for research. Identifying research suitable data from hospital systems is rarely performed using a structured approach. Objective: To define a core set of research suitable data, from multiple hospital datasets and systems for the National Centre for Healthy Ageing Data Platform. Method: Candidate data were identified based on: published literature, researcher survey and quality audit. We recruited researchers and clinicians to participate in a modified Delphi method to achieve consensus on the core data. Live online surveys were conducted across 11 datasets. Participants rated the relevance of each data item using a Likert scale and provide additional feedback. Acceptance criteria were set at >70% agreement. Items meeting this threshold were included in the core dataset. Results: The end user group contained 16 university and 17 clinician researchers. An initial 144 data items were presented for consideration. Experts provided additional details for specialised items. Consensus to include an item was reached after one ( n = 127) or two ( n = 3) rounds with an additional three items identified by end-users. The final core dataset included 133 items across all 11 datasets. Conclusion: Our approach proved effective in reaching consensus among diverse researchers, ensuring that the selected data items are relevant for a range of purposes. Implications for health information management practice: Having a core dataset will support targeted activities that ensure these items are accurate, readily accessible and used appropriately to support patient care, administrative tasks and research.