Clostridium difficile Infections: Diagnosis, Treatment, and Prevention
Given the frequency and severity of CDI and the fact that future reimbursement policy may withhold payment for hospital-acquired infections, this is an under-researched topic. More precise estimates of the magnitude of differences in test sensitivities and specificities are needed. More importantly, studies have not established that any of the possible differences in test accuracy would lead to substantially different patient outcomes in clinical practice. Therefore, limited evidence on the comparisons of immunoassays and genetic tests do not provide guidance to change current diagnostic approaches. More research on effective treatment and unintended consequences of treatment, such as resistance, is needed. Gut flora may be important, but improved understanding of healthy gut ecology and the complex interactions is necessary before continuing to pursue probiotics. Comparisons of oral vancomycin and metronidazole as well as vancomycin and fidaxomicin demonstrate similar initial cure rates. Fidaxomicin is associated with significantly lower recurrence rates than vancomycin for patients infected with non-NAP1 strains of C. difficile. For patients with the NAP1 strain, recurrence rates did not differ by treatment. For patients with multiple recurrences, use of C. difficile immune whey or fecal flora reconstitution show promise, but evidence is low. Limited evidence supports current practices for prevention, including appropriate antibiotic stewardship to reduce the use of broad-spectrum antibiotics.
- 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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