Help
Subscribe


All of GastroHep is now free access! - Click here to register Read For FREE - Our full range of review articles
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy Profile of Guido Tytgat Profile of Pete Peterson Profile of Peter Cotton 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

 06 March 2015

Advanced search
 06 March 2015 
Second anti-TNF in IBD
 06 March 2015 
Efficacy of Hep E vaccine
 06 March 2015 
Steroid therapy for eosinophilic esophagitis
 05 March 2015 
EPHXI polymorphism and esophageal cancer risk
 05 March 2015 
Infliximab and immunosuppressant therapy in ulcerative colitis
 05 March 2015 
Neuroendocrine carcinoma of the colon and rectum
 04 March 2015 
Multidisciplinary management of rectal cancer
 04 March 2015 
Management of IBD
 04 March 2015 
Progression of Barrett's
 03 March 2015 
EPHX1 polymorphism and esophageal cancer risk
 03 March 2015 
Risk of anastomotic leak after colectomy
 03 March 2015 
GI bleeding in chronic kidney disease patients on aspirin
 02 March 2015 
Genes and early diagnosis of IBD
 02 March 2015 
Assessment of GERD
 02 March 2015 
Liver disease in patients awaiting liver transplant
 27 February 2015 
Obesity and weight-loss therapy
 27 February 2015 
MRE performance in staging liver fibrosis
 27 February 2015 
Bleeding in diverticulosis
 26 February 2015 
Familial colorectal cancer risk and primary cancer
 26 February 2015 
Herbal products and the liver
 26 February 2015 
Questionnaires for GERD
 25 February 2015 
Exercise and NAFLD
 25 February 2015 
IBD in Korea
 25 February 2015 
Immunosuppressive therapy and T. whipplei
 24 February 2015 
Clinical trials in pediatric IBD
 24 February 2015 
Reducing health care costs in IBD
 24 February 2015 
GI bleeding after anticoagulation interruption
 23 February 2015 
Visceral abdominal obesity and IBS
 23 February 2015 
Crohn's outcomes with infliximab
 23 February 2015 
Intestinal microbiota and celiac disease
 20 February 2015 
H. pylori eradication
 20 February 2015 
Antiviral treatment and Hep C outcomes
 20 February 2015 
C. diff testing in IBD
 19 February 2015 
Peptic ulcer bleeding mortality in liver disease
 19 February 2015 
Intestinal microbiota in IBS
 19 February 2015 
Fecal microbial transplant in active Crohn's disease
 18 February 2015 
Genetic testing and GI cancers
 18 February 2015 
Placebo analgesia in functional abdominal pain
 18 February 2015 
Successful Hep C virus therapy
 17 February 2015 
Quality measures and colonoscopist selection
 17 February 2015 
Global incidence of esophageal cancer
 17 February 2015 
Anti-viral treatment and survival in Hep C
 16 February 2015 
Saliva for the diagnosis of GERD
 16 February 2015 
H pylori eradication therapy
 16 February 2015 
Medical marijuana for digestive disorders
 13 February 2015 
Beta-blockers in cirrhosis
 13 February 2015 
Liver disease and peptic ulcer bleeding
 13 February 2015 
Prevalence of microscopic colitis
 12 February 2015 
Liver disease in chronic Hep C
 12 February 2015 
Patient-reported outcomes in Hep C
 12 February 2015 
Patients’ colonoscopist selection
 11 February 2015 
Hepatic decompensation in Hep C cirrhosis
 11 February 2015 
Guidelines for the diagnosis of hepatocellular carcinoma
 11 February 2015 
NAFLD and CVD
 10 February 2015 
Percutaneous endoscopic gastrostomy
 10 February 2015 
Factors that influence hepatic steatosis
 10 February 2015 
Gene variants and Crohn's susceptibility
 09 February 2015 
Factors that influence gallstone surgery
 09 February 2015 
Factors associated with increased mortality in cirrhosis
 09 February 2015 
Use of immunomodulators in IBD

Blackwell Publishing


GastroHep.com is a Blackwell Publishing registered trademark
© 2015 Wiley-Blackwell and GastroHep.com and contributors
Privacy Statement
Disclaimer
About Us