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Clostridium Difficile Infection Cdi Prevention
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Book Synopsis Clostridium Difficile Infection in Long-Term Care Facilities by : Teena Chopra
Download or read book Clostridium Difficile Infection in Long-Term Care Facilities written by Teena Chopra and published by Springer Nature. This book was released on 2019-11-14 with total page 80 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book aims to fill knowledge gap among healthcare workers about Clostridium difficile (also known as C.difficile and CDI) among aging patients, especially those in long-term care facilities (LTCFs). Written by experts in infectious diseases and geriatric medicine, this book provides comprehensive information on all aspects of CDI pertaining to LTCF settings, including epidemiology, diagnosis, prevention, management and the unique challenges faced by LTCFs with regards to the CDI problem. The book begins by introducing the topic as it relates to aging patients before delving into the various aspects of CDI management. Topics include infection control and prevention, treatment of CDI, and the establishment of antibiotic stewardship programs to reduce inappropriate antibiotic use and reduce CDI rates. The book also features a chapter on probiotics for the prevention of CDI and new strategies to monitor environmental cleaning practices of CDI patient rooms that do not appear in any other resource. Clostridium Difficile Infection in Long-Term Care Facilities is an excellent resource for geriatricians, infectious diseases specialists, long-term care administrators, nurses, pharmacists, researchers, and all clinicians working with infections in long-term care settings.
Book Synopsis Guideline for Isolation Precautions in Hospitals by : Julia S. Garner
Download or read book Guideline for Isolation Precautions in Hospitals written by Julia S. Garner and published by . This book was released on 1983 with total page 88 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Clostridioides difficile by : Henning Sommermeyer
Download or read book Clostridioides difficile written by Henning Sommermeyer and published by Springer Nature. This book was released on 2021-09-27 with total page 96 pages. Available in PDF, EPUB and Kindle. Book excerpt: The book provides a comprehensive overview of the current knowledge about Clostridioides (C.) difficile (formerly known as Clostridium difficile) and Clostridioides difficile infections (CDI). The diseases caused by C. difficile range from mild diarrhea to fulminant and in some cases fatal colitis. Historically, CDI was considered mainly as a hospital-acquired problem. Today, a significant portion of CDI is community acquired. Triggered by the introduction of new antibiotics, hypervirulent and multi-drug resistant strains of C. difficile (e.g., C. difficile ribotype R027) have emerged and spread across the globe. The volume covers the microbiology, pathophysiology, epidemiology, risk factors for CDI, diagnosis, clinical pictures, treatment and prophylaxis. It includes an extensive reference list that allows an easy navigation through the original research publications. Clostridioides difficile helps the reader gain a better understanding of C. difficile, the challenges that may arise and the available treatment options. Given its broad coverage and features, it will appeal to a wide readership, from gastroenterologists through general physicians, nurses, and other healthcare providers, to students.
Book Synopsis Clostridium Difficile Infection (CDI) Prevention by : Fremah Nuamah
Download or read book Clostridium Difficile Infection (CDI) Prevention written by Fremah Nuamah and published by . This book was released on 2014 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: The impact of bed occupancy (BO) rate, overcrowding and length of hospital stay on the spread of clostridium difficille infection (CDI) has become a major concern in healthcare as well as a challenge in maintaining patient safety in hospital settings. One major objective of this project is to establish that high bed occupancy rates is a compelling danger for the spread of CDI in the hospital setting. However, Kaier, K. K., Mutters, N. T., and Frank, U. U. 2012). noted in their studies that leaving hospital beds empty creates a potential for financial burden. The assessment, control, implementation, evaluation, and dissemination plans with literature reviews are presented in this project. CDI can spread from patient to patient through the contaminated hands of healthcare providers, patients and families by spore forming bacterium of CDI. Improving hand hygiene, and judiciously adhering to infection control protocols reduces the spread of CDI and other hospital acquired infections (HAIs) in different settings. Bed management policies and maximum bed occupancy rates are integral part of infection control and need to be addressed. The earlier patients are discharged from hospital beds to their homes, the greater the chance to prevent the spread of CDI. Studies have shown that a strong correlation exist between high rate of bed occupancy and the spread of CDI. Two of such are Aziz, A. 2013, who concluded in his report that it is essential to document every bowel movement to indicate the control of C-difficiile and information on preventive measures, should be made accessible to patients and their families. Lanzas, C.,& Dubberke, E. R. 2014). who reported testing for asymptomatic carriers on admission may decrease both the number of new colonizations and hospital-onset cases of CDI.
Book Synopsis Chalk Talks in Internal Medicine by : Somnath Mookherjee
Download or read book Chalk Talks in Internal Medicine written by Somnath Mookherjee and published by Springer Nature. This book was released on 2020-09-30 with total page 347 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book provides teaching scripts for medical educators in internal medicine and coaches them in creating their own teaching scripts. Every year, thousands of attending internists are asked to train the next generation of physicians to master a growing body of knowledge. Formal teaching time has become increasingly limited due to rising clinical workload, medical documentation requirements, duty hour restrictions, and other time pressures. In addition, today’s physicians-in-training expect teaching sessions that deliver focused, evidence-based content that is integrated into clinical workflow. In keeping with both time pressures and trainee expectations, academic internists must be prepared to effectively and efficiently teach important diagnostic and management concepts. A teaching script is a methodical and structured plan that aids in effective teaching. The teaching scripts in this book anticipate learners’ misconceptions, highlight a limited number of teaching points, provide evidence to support the teaching points, use strategies to engage the learners, and provide a cognitive scaffold for teaching the topic that the teacher can refine over time. All divisions of internal medicine (e.g. cardiology, rheumatology, and gastroenterology) are covered and a section on undifferentiated symptom-based presentations (e.g. fatigue, fever, and unintentional weight loss) is included. This book provides well-constructed teaching scripts for commonly encountered clinical scenarios, is authored by experienced academic internists and allows the reader to either implement them directly or modify them for their own use. Each teaching script is designed to be taught in 10-15 minutes, but can be easily adjusted by the reader for longer or shorter talks. Teaching Scripts in Internal Medicine is an ideal tool for internal medicine attending physicians and trainees, as well as physician’s assistants, nurse practitioners, and all others who teach and learn internal medicine.
Author :U. S. Department of Health and Human Services Publisher :CreateSpace ISBN 13 :9781484054925 Total Pages :266 pages Book Rating :4.0/5 (549 download)
Book Synopsis Effectiveness of Early Diagnosis, Prevention, and Treatment of Clostridium Difficile Infection by : U. S. Department of Health and Human Services
Download or read book Effectiveness of Early Diagnosis, Prevention, and Treatment of Clostridium Difficile Infection written by U. S. Department of Health and Human Services and published by CreateSpace. This book was released on 2013-04-06 with total page 266 pages. Available in PDF, EPUB and Kindle. Book excerpt: Clostridium difficile infection (CDI) is a serious healthcare-associated infection and a growing health care problem. C. difficile is a Gram-positive, spore-forming, anaerobic bacterium that, when ingested, can cause CDI if it is a toxigenic strain. CDI symptoms include varying levels of diarrhea severity, as well as pseudomembranous colitis and toxic megacolon. CDI incidence is estimated at 6.5 cases per 10,000 patient days in hospital. About 250,000 hospitalizations were associated with CDI in 2005. Direct attributable mortality from CDI has been reported to be as high as 6.9 % of cases. Elderly people in hospitals account for the vast majority of severe morbidity and mortality. Residents of long-term care facilities are also at higher risk. Incidence rates may increase by fourfold or fivefold during outbreaks. In addition to institutional care environments, C. difficile is also common in the community, being easily isolated from soil and water samples. Community-associated CDI rates are generally much lower, accounting for 27 % of all CDI cases in a recent prevalence study, but are also on the rise. However, the source of the C. difficile organisms responsible for cases of CDI in the community is not well understood. In order for CDI to develop, a person must be infected with a strain of C. difficile capable of making toxin in the person's colon. Approximately 1–2 % of healthy individuals are colonized with C. difficile. If these people have usual, healthy colonic flora, the risk of CDI is very low. There is a small risk of CDI if the colon flora becomes disturbed, commonly through antibiotic use, while the person is colonized with a toxigenic strain. Antibiotics that disturb colon flora enough to allow CDI to develop must get into the colon, and they are associated with alterations in relative amounts of colon bacterial constituents. The immune status of the patient also contributes to the risk of developing CDI and the experienced severity. Other risk factors include increasing age, female gender, comorbidities, gastrointestinal procedures, and use of gastric acid suppression medications. Risk profiles for recurrent CDI are similar. One study, which statistically modeled CDI within the hospital setting, suggested that reducing patient susceptibility to infection is more effective in reducing CDI cases than lowering transmission rates. The purpose of this systematic review was to provide an overarching assessment of the evidence for comparing the accuracy of diagnostic tests and the effectiveness of prevention and treatment interventions on initial and recurrent CDI-related patient outcomes in adult patients. The major impetus of this review is the presence of clinical disease, not asymptomatic carriage of the C. difficile organism. The review focuses on adult patients because adults, and particularly elderly adults, carry the large majority of the morbidity and mortality burden. The following Key Questions (KQs) form the basis for this review: KQ 1. How do different methods for detection of toxigenic C. difficile to assist with diagnosis of CDI compare in their sensitivity and specificity? Do the differences in performance measures vary with sample characteristics? KQ 2. What are effective prevention strategies? What is the effectiveness of current prevention strategies? What are the harms associated with prevention strategies? How sustainable are prevention practices in health care (outpatient, hospital inpatient, extended care) and community settings? KQ 3. What are the comparative effectiveness and harms of different antibiotic treatments? Does effectiveness vary by disease severity or strain? Does effectiveness vary by patient characteristics: age, gender, comorbidity, hospital- versus community-acquired setting? How do prevention and treatment of CDI affect resistance of other pathogens? KQ 4. What are the effectiveness and harms of nonstandard adjunctive interventions? In patients with relapse/recurrent CDI?
Book Synopsis Updates on Clostridium difficile in Europe by : Paola Mastrantonio
Download or read book Updates on Clostridium difficile in Europe written by Paola Mastrantonio and published by Springer. This book was released on 2018-01-29 with total page 262 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book outlines the currently available clinical, epidemiological and experimental data on Clostridium difficile infection (CDI) with special emphasis on studies and results achieved in Europe. The incidence and severity of CDI has increased significantly over the last decade, and the book explains why C. difficile, recently reclassified as Clostridioides difficile, remains a significant challenge, also from economic perspective, to health care systems all over the world. The different reservoirs of this ubiquitous microorganism are reviewed as well as the different factors contributing to its virulence, such as toxins and biofilm formation. The rapid evolution of antibiotic resistance is clearly a concern and in a specific way can influence the CDI epidemiology. Additionally, new emerging strains and comparative genomics studies are discussed for their relevance from epidemiological and evolutionary point of view. The book also gives an overview on diagnostics, therapy and surveillance, all of which are still challenging. Therefore, a closer look is taken on the effect of probiotics as an alternative to antibiotics, for prevention and treatment of CDI. Fecal transplantation from healthy donors, passive immunotherapies and vaccines for patients with recurrences are also discussed in dedicated chapters. The book closes with a summary of the history and the achievements of the European Society of Clinical Microbiology and Infectious Diseases Study Group for Clostridium difficile (ESGCD) written by the current and past presidents of the Society. It is the aim of this book to raise awareness on CDI and to disseminate updated information on its prevention, diagnosis and treatment.
Book Synopsis The ASCRS Manual of Colon and Rectal Surgery by : David E. Beck
Download or read book The ASCRS Manual of Colon and Rectal Surgery written by David E. Beck and published by Springer Science & Business Media. This book was released on 2009-06-12 with total page 1042 pages. Available in PDF, EPUB and Kindle. Book excerpt: The ASCRS Textbook of Surgery of the Colon and Rectum offers a comprehensive textbook designed to provide state of the art information to residents in training and fully trained surgeons seeking recertification. The textbook also supports the mission of the ASCRS to be the world’s authority on colon and rectal disease. The combination of junior and senior authors selected from the membership of the ASCRS for each chapter will provide a comprehensive summary of each topic and allow the touch of experience to focus and temper the material. This approach should provide the reader with a very open minded, evidence based approach to all aspects of colorectal disease. Derived from the textbook, The ASCRS Manual of Surgery of the Colon and Rectum offers a “hands on” version of the textbook, written with the same comprehensive, evidence-based approach but distilled to the clinical essentials. In a handy pocket format, readers will find the bread and butter information for the broad spectrum of practice. In a consistent style, each chapter outlines the condition or procedure being discussed in a concise outline format – easy to read, appropriately illustrated and referenced.
Book Synopsis Clostridium difficile Infection, An Issue of Infectious Disease Clinics of North America by : Mark H. Wilcox
Download or read book Clostridium difficile Infection, An Issue of Infectious Disease Clinics of North America written by Mark H. Wilcox and published by Elsevier Health Sciences. This book was released on 2015-04-07 with total page 201 pages. Available in PDF, EPUB and Kindle. Book excerpt: This issue of Infectious Disease Clinics of North America, guest edited by Dr. Mark H. Wilcox, is devoted to Clostridium Difficile Infection. Articles in this issue include: Potential sources of C. difficile for human infection; Colonisation versus carriage of C. difficile; Diagnostic pitfalls in C. difficile infection; The epidemiology of C. difficile infection in and outside of healthcare institutions; What makes epidemic C. difficile strains epidemic?: Fact versus fiction; Environmental interventions to control C. difficile infection; The contribution of strains and hosts to outcomes in C. difficile infection; Treatment of C. difficile infection; Faecal microbiota transplantation for the management of C. difficile infection; The morbidity, mortality, and costs associated with C. difficile infection; The potential of probiotics to prevent C. difficile infection; The prospect for vaccines to prevent C. difficile infection; and Predictive value of models of C. difficile infection.
Book Synopsis Clostridium Difficile Infection (CDI) Laboratory and Prevention Practices Survey, Oregon Hospitals by :
Download or read book Clostridium Difficile Infection (CDI) Laboratory and Prevention Practices Survey, Oregon Hospitals written by and published by . This book was released on 2011 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Updates on Clostridioides difficile in Europe by : Paola Mastrantonio
Download or read book Updates on Clostridioides difficile in Europe written by Paola Mastrantonio and published by Springer Nature. This book was released on 2024-01-04 with total page 368 pages. Available in PDF, EPUB and Kindle. Book excerpt: This fully updated second edition outlines the currently available clinical, epidemiological and experimental data on Clostridioides difficile infections(CDI) with special emphasis on studies and results achieved in Europe. The incidence and severity of CDI has increased significantly over the last decade, and the book explains why C. difficile, recently reclassified as Clostridioides difficile, remains a significant challenge, also from economic perspective, to health care systems all over the world. The different reservoirs of this ubiquitous microorganism are reviewed as well as the different factors contributing to its virulence, such as toxins and biofilm formation. The rapid evolution of antibiotic resistance is clearly a concern and in a specific way can influence the CDI epidemiology. Additionally, new emerging strains and comparative genomics studies are taken into consideration for their relevance from epidemiological and evolutionary point of view. The book also gives an overview on diagnostics, therapy and surveillance, all of which are still challenging. Therefore, a closer look is taken on the effect of probiotics as an alternative to antibiotics, for prevention and treatment of CDI. Fecal transplantation from healthy donors, passive immunotherapies and vaccines for patients with recurrences are also discussed in dedicated chapters. New topics included sporulation and membrane vesicles in C. difficile. The book closes with a summary of the history and the achievements of the European Society of Clinical Microbiology and Infectious Diseases Study Group for Clostridium difficile (ESGCD) written by the current and past presidents of the Society. It is the aim of this book to raise awareness on CDI and to disseminate updated information on its prevention, diagnosis and treatment.
Author :U. S. Department of Health and Human Services Publisher :CreateSpace ISBN 13 :9781484033043 Total Pages :66 pages Book Rating :4.0/5 (33 download)
Book Synopsis Future Research Needs for Prevention and Treatment of Clostridium Difficile Infection by : U. S. Department of Health and Human Services
Download or read book Future Research Needs for Prevention and Treatment of Clostridium Difficile Infection written by U. S. Department of Health and Human Services and published by CreateSpace. This book was released on 2013-04-04 with total page 66 pages. Available in PDF, EPUB and Kindle. Book excerpt: Clostridium difficile infection (CDI) is a serious healthcare-associated infection and a growing health care problem, especially with the emergence of more virulent strains in the early 2000s. Clostridium difficile was first recognized as having the ability to cause pseudomembranous colitis in the late 1970s. CDI is now the most common cause of nosocomial infectious diarrhea. Asymptomatic colonization in healthy adults has been observed in only 3 percent of persons, while the prevalence of such colonization among residents in long-term-care facilities approaches 50 percent. Individuals colonized with Clostridium difficile serve as a reservoir for infection by contaminating the environment with Clostridium difficile spores, thus leading to the spread of the organism on the hands of health care workers or via use of medical equipment. CDI is increasing in incidence and, in all likelihood, severity. The number of cases diagnosed among patients discharged from hospitals increased from 31 per 100,000 persons in 1996 to 84 per 100,000 persons in 2005. Infection due to a relatively new strain of Clostridium difficile, termed “North American pulsed-field gel electrophoresis type 1” (NAP1), is felt to be at least partially responsible for this increased incidence of CDI as well as for the increased severity of clinical illness. The NAP1 strain is capable of producing more than 15 times the quantity of both toxins A and B, which are directly responsible for the damage to the intestinal tract of infected patients. Hence, CDI is not only now more common, but also more severe, leading to an attributable mortality of up to 16 percent of all deaths. A comparative effectiveness review (CER) was prepared by the Minnesota Evidence-based Practice Center (EPC) on Comparative Effectiveness of Early Diagnosis, Prevention, and Treatment of Clostridium difficile Infection (December 2011). The purpose of the CER was to provide an overarching assessment of the evidence for comparing the accuracy of diagnostic tests and the effectiveness of prevention and treatment interventions on initial and recurrent CDI related patient outcomes in adults. Key informants, provided input to the EPC on the scope of the CER, agreed that its greatest contribution to the field could be to have an independent organization provide a comprehensive review of the major concerns of the field for both clinicians and researchers. The major impetus underlying the SR was a concern about the presence of clinical disease, not asymptomatic carriage of the Clostridium difficile organism.1 Molecular epidemiological studies whose main purpose was to identify the strains of Clostridium difficile present in the population were outside the scope of the CER. The CER focused on adult patients as they, particularly elderly adults, carry the most of the morbidity and mortality burden.The CER addressed the following Key Questions (KQs): 1. How do different methods for detection of toxigenic Clostridium difficile to assist with diagnosis of CDI compare in their sensitivity and specificity? a. Do the differences in performance measures vary with sample characteristics? 2. What are effective prevention strategies? a. What is the effectiveness of current prevention strategies? b. What are the harms associated with prevention strategies? c. How sustainable are prevention practices in health care (outpatient, hospital inpatient, extended care) and community settings? 3. What are the comparative effectiveness and harms of different antibiotic treatments? a. Does effectiveness vary by disease severity or strain? b. Does effectiveness vary by patient characteristics: age, gender, comorbidity, hospital versus community-acquired setting? c. How do prevention and treatment of CDI affect resistance of other pathogens? 4. What are the effectiveness and harms of nonstandard adjunctive interventions? a. In patients with relapse/recurrent CDI?
Book Synopsis Potentially Preventable Emergency Department Visits by Nursing Home Residents by : Christine Caffrey
Download or read book Potentially Preventable Emergency Department Visits by Nursing Home Residents written by Christine Caffrey and published by . This book was released on 2010 with total page 8 pages. Available in PDF, EPUB and Kindle. Book excerpt: KEY FINDINGS: Data from the National Nursing Home Survey, 2004. In 2004, 8 percent of U.S. nursing home residents had an emergency department (ED) visit in the past 90 days. Among nursing home residents with an ED visit in the past 90 days, 40 percent had a potentially preventable ED visit. Injuries from falls were the most common conditions accounting for potentially preventable ED visits by nursing home residents. Nursing home residents who had a potentially preventable ED visit in the past 90 days had shorter lengths of stay and more medications In 2004, 8 percent of U.S. nursing home residents had an emergency department (ED) visit in the past 90 days. Among nursing home residents with an ED visit in the past 90 days, 40 percent had a potentially preventable ED visit. Injuries from falls were the most common conditions accounting for potentially preventable ED visits by nursing home residents. Nursing home residents who had a potentially preventable ED visit in the past 90 days had shorter lengths of stay and more medications.
Book Synopsis Emerging Transplant Infections by : Michele I. Morris
Download or read book Emerging Transplant Infections written by Michele I. Morris and published by Springer. This book was released on 2021-06-22 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: The field of transplant medicine has evolved significantly since the first kidney transplant was performed in 1954. Innovations in transplant immunosuppression have lowered the risk of organ rejection so that infectious complications are now the leading cause of hospitalization and mortality after solid organ transplant. Infection is also cited as the leading cause of non-relapse mortality after stem cell transplantation. As transplant centers have recognized the importance of transplant specific expertise in patient outcomes, the field of transplant infectious diseases has expanded into a recognized and highly valued subspecialty. International growth in solid organ and stem cell transplantation has outpaced access to such expertise, with some centers employing microbiology laboratory directors and transplant nephrologists as their lead infectious diseases consultants. This has been a particular challenge as the use of novel immunosuppressive regimens in new geographic and immigrant populations have fueled the emergence of new infection syndromes, with the initial presentation sometimes occurring in this most vulnerable patient population. This digital-first book is designed to meet the needs of practitioners engaged in transplant infectious disease practice who need more depth than they are able to find in UpToDate. It provides an overview of emerging infectious disease challenges with clinically relevant information regarding the epidemiology, diagnosis, management, and prevention of infections in solid organ and stem cell transplant recipients. Each chapter focuses on a clinical syndrome or pathogen with new or emerging implications for transplant patients. Given the rapidly evolving nature of emerging infections and topics in transplant infections, no resource has been published on these increasingly notorious issues; this this text is written by top, global experts who regularly update the material to ensure that readers will always have access to the most cutting edge material available. The editorial team consists of three experienced leaders in the field, all of whom have a strong record of scholarship and publication, as well as an international reputation. All three have focused their academic careers on emerging infectious diseases in transplantation, including a current and a past president of various infectious diseases and transplantation societies. The editors are also experienced reviewers and authors who have collaborated on multiple previous projects. All are committed to this project as a unique opportunity to make an important contribution to their field.
Book Synopsis Evidence-Based Critical Care by : Robert C. Hyzy
Download or read book Evidence-Based Critical Care written by Robert C. Hyzy and published by Springer. This book was released on 2017-05-30 with total page 769 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book provides learners with a unique opportunity by virtue of the format outlined above. Each case presentation has a case vignette, which leads up to an important clinical question, and is followed by additional discussion which resolves the question posed. This is a new way to present knowledge in a medical book and should help critical care practitioners, fellows, residents, allied health professionals and students expand their critical care knowledge in an efficient and effective manner. This approach should also benefit those preparing for board examinations.
Book Synopsis Early Diagnosis, Prevention, and Treatment of Clostridium Difficile by : Mary Butler
Download or read book Early Diagnosis, Prevention, and Treatment of Clostridium Difficile written by Mary Butler and published by . This book was released on 2016 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: OBJECTIVE: Update a 2011 review of differences in accuracy of diagnostic tests and the effects of interventions to prevent and treat Clostridium difficile infection (CDI) in adults. DATA SOURCES: Medline(r), the Cochrane Clinical Trials Registry, and Embase(r) from 2010 through April 2015 plus reference lists of included studies and recent systematic reviews. METHODS: Two investigators screened abstracts and full texts of identified references for eligibility. Eligible studies included studies of sensitivity and specificity for diagnostic tests in patients at risk for CDI. We included randomized controlled trials or high-quality cohort studies enrolling adult patients with CDI or suspected CDI for treatment interventions. Prevention studies also included adult patients at risk for CDI and observational study designs. Two investigators extracted data, assessed individual study risk of bias, and evaluated the strength of evidence for each comparison and outcome. Pooled estimates were analyzed to assess the efficacy and comparative effectiveness of a variety of treatments. RESULTS: We identified 37 diagnostic studies and 56 studies evaluating prevention or treatment interventions to update the review. High-strength evidence showed that nucleic amplification tests were sensitive and specific for CDI when using culture as the reference standard. Low-strength evidence was found that some institutional prevention interventions, such as antibiotic prescribing practices and transmission interruption (terminal room cleaning with hydrogen peroxide vapor and handwashing campaigns), reduce CDI incidence. Low-strength evidence also suggested that prevention programs can be sustained over several years. For CDI treatment, vancomycin is more effective than metronidazole (high-strength evidence), and the effect does not vary by severity (moderate-strength evidence). Fidaxomicin remains noninferior to vancomycin for the initial cure of CDI (moderate-strength evidence) but is superior to vancomycin for prevention of recurrent CDI (now high-strength evidence). Although both fecal microbiota transplantation (FMT) and probiotics were the subject of a significant number of new studies, the overall high risk of bias of many of these studies necessitated ratings of low strength of evidence. Specifically, low-strength evidence suggests that FMT may have a significant effect on reducing recurrent CDI. Similarly, low-strength evidence suggests that lactobaccilus strains and multiorganism probiotics also can reduce recurrent CDI. However, Saccharomyces boulardii was no more effective than placebo in preventing recurrent CDI. Evidence for FMT for refractory CDI was insufficient. Few studies reported adverse events; when reported, few events were noted. CONCLUSIONS: Research on diagnostic testing for and interventions to treat CDI expanded considerably in 4 years. Nucleic acid amplification tests have high sensitivity and specificity for CDI. Vancomycin is more effective than metronidazole for initial CDI, while fidaxomicin is more effective than vancomycin for the prevention of recurrent CDI. FMT and lactobacillus probiotics to restore colonic biodiversity and improve patient resistance to CDI or recurrence have low-strength but relatively consistent positive evidence for efficacy.
Book Synopsis Clinical Algorithms in General Surgery by : Salvatore Docimo Jr.
Download or read book Clinical Algorithms in General Surgery written by Salvatore Docimo Jr. and published by Springer. This book was released on 2019-02-04 with total page 786 pages. Available in PDF, EPUB and Kindle. Book excerpt: As the field of general surgery continues to expand, the diagnostic and therapeutic pathways are becoming more complex. The diagnostic modalities available to the clinician can be both very helpful but also overwhelming considering the findings can often determine the scope of treatment for a patient. This text will take the major pathologies of the systems commonly studied in general surgery and present them in a unique format based upon algorithms. The algorithms will begin with the clinical presentation of the patient, work its way through the various diagnostic modalities available to the surgeon, and finally allow the physician to make a decision regarding treatment options based upon various patterns in the algorithms. This text will become a very useful resources for surgeons as it allows complex clinical pathways to be conveniently organized in logical algorithms. It will become a concise yet comprehensive manual to assist in clinical decision making. All algorithms will be reviewed by experts in their field and include the most up-to-date clinical and evidence-based information. Clinical Algorithms in General Surgery provides a useful resource for surgeons in clinical practice as well as surgical residents, and surgical attendings who are preparing for board examinations. See sample algorithm in Attachments.
