Clostridium difficile Infections: Diagnosis, Treatment, and Prevention
Gaps in Knowledge
The available research on effective diagnosis, treatment, and prevention of CDI highlights the significant gaps in our knowledge and where future research is needed. Newer DNA-based diagnostic C. difficile assays have given promising initial results; however, it is not clear how differences in diagnostic test sensitivity and specificity affect clinical decisions and patient outcomes. Research is needed to determine the optimal institution-wide CDI-prevention strategies for addressing multiple potential routes of transmission and for reducing patient susceptibility. Research is still needed to determine if nonantibiotic interventions—such as probiotics, prebiotics, toxin-absorbing compounds, and fecal flora reconstitution, among others—can be effective in preventing primary or recurrent CDI. Limited available evidence suggests that oral vancomycin may provide higher initial cure rates for severely ill CDI patients; however, more research is necessary in this patient population in order to draw meaningful conclusions. A consensus needs to be reached between clinical and research-oriented definitions of CDI with regard to diarrhea, that is, the number and consistency of stools.
Keywords: gaps in knowledge | diagnostic assays | prevention strategies | probiotics | prebiotics | fecal transplant | definitions
- Butler M, Bliss D, Drekonja D, Filice G, Rector T, MacDonald R, Wilt T. Effectiveness of Early Diagnosis, Prevention, and Treatment of Clostridium difficile Infection. Comparative Effectiveness Review No. 31 (Prepared by the Minnesota Evidence-based Practice Center under Contract No. 290-02-0009.) AHRQ Publication No. 11(12)-EHC051-EF. Rockville, MD. Agency for Healthcare Research and Quality. December 2011. Available at: http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=772.
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