Help
Subscribe


GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy

 10 February 2016

Advanced search
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy Profile of Roy Pounder

Home

News  
Journals
Review Articles
Slide Atlas
Video Clips
Online Books
Advanced Digestive Endoscopy
Classical Cases
Conference Diary
PubMed
International GH Links
USA GH Links
National GH Links
National GI Societies
Other Useful Links




Emails on Gastroenterology and Hepatology
the National AIDS Treatment Advocacy Project
Visit the gastroenterology section of the EUMS

News

C. difficile in 2011 is less severe with better outcomes than the infection in 2008

The latest issue of the American Journal of Gastroenterology compares the demographics, medication exposure, treatment patterns, and outcomes of patients with C. difficile in 2 different time periods.

News image

Over the past decade, the epidemiology of Clostridium difficile infection (CDI) has shown a remarkable increase in incidence with an associated increase in severity.

Dr Paul Feuerstadt and colleagues from Connecticut, USA compared the demographics, medication exposure, evaluation, treatment patterns, and outcomes of patients with CDI in 2 different time periods, including 2006–2008 and 2009–2011.

The researchers hypothesized that mortality is decreasing with increasing appropriateness of medical management.

The team retrospectively identified consecutive patients admitted to Montefiore Medical Center between 1/1/2006 and 12/31/2011 with symptomatic diarrhea, and a positive C. difficile toxin assay.

Factors associated with 30-day mortality include age, white blood cells, and albumin level
American Journal of Gastroenterology

The cohort was subdivided into those diagnosed in 2006–2008, and 2009–2011.

The research team obtained key parameters at the time of diagnosis including demographics, medication exposure, medical comorbidities, laboratory data, CDI evaluation, and various outcome measures.

The team created a subcohort for each time frame of patients diagnosed with severe CDI defined by white blood cell count >15,000 cells/μl, and albumin <3.0 g/dl and made the same comparisons as for the overall cohort.

The resesarch team identified 4 cohorts including CDI 2006–08, CDI 2009–11, severe CDI 2006–08, and severe CDI 2009–11.
 
CDI 09–11 patients were older and had higher Charlson comorbidity scores than did those in the CDI 06–08 cohort.

The team observed no significant demographic differences in the severe cohort.

For both the overall and severe cohorts, there was more macrolide exposure before diagnosis with CDI, and lower rates of quinolone exposure in the more recent era.

The researchers found that the disease process also appeared less severe in the CDI 2009–11 cohort with lower peak white blood cells during admission and at diagnosis.

Treatment patterns appeared more aggressive during the more recent time frame, with shorter durations of oral metronidazole, longer durations of IV metronidazole, more frequent use of vancomycin as the sole therapy, more frequent switching from metronidazole to vancomycin, and less frequent exposure to any metronidazole throughout treatment in the overall cohort.

The researchers found that the 30-day mortality decreased significantly in both the overall, and the severe cohorts from CDI 06–08 to CDI 09–11, with mortality decreasing significantly in the 8th and 9th decades of life in the overall cohort and in the 8th, 9th, and 10th decades in the severe cohort.

Dr Feuerstadt's team concludes, "In an urban United States population, CDI 2009–11 showed changes in medication exposures, less severe disease, and more aggressive management with better outcomes and decreased mortality compared with CDI 06–08."

"The most important factors associated with 30-day mortality in both an overall and severe CDI population include age, white blood cells, and albumin level at the time of diagnosis."

Am J Gastroenterol 2014; 109:1265–1276
18 August 2014

Go to top of page Email this page Email this page to a colleague

 10 February 2016 
NAFLD in Veterans in the USA
 10 February 2016 
Rectosigmoidoscopy vs colonoscopy in ulcerative colitis
 10 February 2016 
Liver cancer and primary biliary cirrhosis
 09 February 2016 
Cancer-specific prognosis in octogenarians with colorectal cancer
 09 February 2016 
Eosinophilic esophagitis and parental allergies
 09 February 2016 
Bowel preparation for colonoscopy screening
 08 February 2016 
Immunity in the human gut
 08 February 2016 
Cancelled colonoscopy appointments
 08 February 2016 
Cognitive function in Crohn's disease
 05 February 2016 
Helicobacter cinaedi bacteremia
 05 February 2016 
Methotrexate and remission in ulcerative colitis
 05 February 2016 
Treatment for ileal pouch-anal anastomosis for Crohn’s colitis
 04 February 2016 
Diabetes and liver cancer
 04 February 2016 
Colorectal cancer screening
 04 February 2016 
H. pylori and coronary heart disease 
 03 February 2016 
Acute diverticulitis and IBS 
 03 February 2016 
Microbiota of the colonic mucosa and chronic constipation
 03 February 2016 
Guidelines for chronic pancreatitis
 02 February 2016 
Ramosetron and IBS-diarrhea
 02 February 2016 
IBD emergency department visits
 02 February 2016 
Probiotics for H. pylori management
 01 February 2016 
Depressive symptoms in IBD 
 01 February 2016 
Obesity and hepatocellular carcinoma risk
 01 February 2016 
Managing HBV in pregnancy
 29 January 2016 
Colorectal cancer after colonoscopy
 29 January 2016 
Acute diverticulitis in immunosuppressed patients
 29 January 2016 
Vitamin D and colorectal cancer risk
 28 January 2016 
Tissue anti-TNF drug levels and IBD
 28 January 2016 
First line treatment of H. pylori infection
 28 January 2016 
Tetracycline for rosacea increases the risk of IBD
 27 January 2016 
Steroids in children with Crohn's
 27 January 2016 
Self-management IBS program 
 27 January 2016 
Human gut microbiome in IBD 
 26 January 2016 
Smoking and symptomatic diverticular disease
 26 January 2016 
Step-down therapy in PPI-responsive esophageal eosinophilia 
 26 January 2016 
Diet and IBD risk
 25 January 2016 
IBD monitoring using smartphones
 25 January 2016 
Self-management IBS program
 25 January 2016 
Colorectal cancer after a negative screening sigmoidoscopy
 22 January 2016 
Length of Barrett's and cancer
 22 January 2016 
Psychosocial interventions and alcohol abstinence in chronic liver disease
 22 January 2016 
Helicobacter pylori antibiotic resistance
 21 January 2016 
Increasing adenoma detection rate during colonoscope withdrawal
 21 January 2016 
Microscopic colitis current concepts
 21 January 2016 
Statins as a management strategy for constipation 
 20 January 2016 
Health status after bariatric surgery
 20 January 2016 
Hep E infection in West Africa
 20 January 2016 
Preventing endoscopic bacterial transmission
 19 January 2016 
PPIs and phlebotomy in hereditary hemochromatosis
 19 January 2016 
Predicting liver cirrhosis in Hep C
 19 January 2016 
Frozen vs fresh fecal microbiota transplantation
 18 January 2016 
Hospitalization for diverticulitis in the USA
 18 January 2016 
H. pylori and gastric cancer across Europe
 18 January 2016 
Enteral nutrition in children with Crohn's
 15 January 2016 
Alcohol- and HCV-related hepatocellular carcinoma
 15 January 2016 
Recurrent colonic diverticulitis
 15 January 2016 
Colonic diverticula and colorectal cancer risk
 14 January 2016 
Risk stratification of incidentally discovered gallstones
 14 January 2016 
Treatment of refractory cholestatic pruritus
 14 January 2016 
Colonic diverticula and colorectal cancer risk 

Blackwell Publishing


GastroHep.com is a Blackwell Publishing registered trademark
© 2016 Wiley-Blackwell and GastroHep.com and contributors
Privacy Statement
Disclaimer
About Us