See previous blogs here.
And now for a smattering of interesting C. difficile associated publications since the last time I posted on this topic...
- An entire issue of the journal Anaerobe dedicated to C. difficile related issues is available here.
Notable articles in this journal include:- reviews of diagnostic testing
- probiotics (lack of efficacy in prevention and treatment according to the authors)
- fecal transplant (suggests that it does indeed work -- even if gross)
- the 'rixamixin chaser' (shows promise in multiple relapses, but not the magic bullet
- The potential role of an antitoxin (NEJM here)
- The development of disease in patients status post collectomy!
- The perils and difficulties of diagnosis.
- EIA sensitivity is relatively poor - ~60-70%
- GDH has better sensitivity, but poor specificity
- Cytotoxic assays are time consuming and expensive
- PCR may be less effort dependent but has an upfront cost
- An algorithm suggested is GDH as a screen, if positive confirm with EIA, if negative EIA do PCR or cytotoxic assay.
- A set of european guidelines, which seem quite reasonable.
- An article on the challenges of treating patients in the ICU including:
- lack of sensitivity of testing means potential undertreating of critically ill patients
- the role of vancomycin in severe disease
- the absence of diarrhea (as also reported from Toronto) in up to 20% of critically ill patients because of illeus, post-operative status, or narcotics
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