1,022
edits
Changes
Jump to navigation
Jump to search
Created page with "Diagnosis and Treatment or C.ostradaul der Natasha Bagdasarian et al. Published in JAMA 2019. Systematic review of 116 included studies between 1978 and 2014. DIAGNOSIS Labora..."
Diagnosis and Treatment or C.ostradaul der
Natasha Bagdasarian et al.
Published in JAMA 2019.
Systematic review of 116 included studies between 1978 and 2014.
DIAGNOSIS
Laboratory testing cannot distinguish between asymptomatic colonization and
¿Eyed frat' cuitisten a forfindsfficile. The best test performance characteristics
-Diagnostic criteria
--Diarrhea
-Positive stool test for toxigenic C. diff or toxins or pseudomembranous colitis
-Diagnostic approaches
-Toxigenic Culture (TC) and/or Cell Cytotoxicity Assay (CCA)
---Anaerobic culture for 24-48 hrs followed by colony selection and culture with
human cells to test for cell cytotoxicity which takes an additional 24-48 hours.
-Gold standard
--- Time consuming and difficult, up to 5 days
---Detects a little as 3 picograms of toxin
-Stool antigen looks for Glutamate dehydrogenase (COH) via ELISA (SIA)
---Does not distinguish between toxigenic and non-toxigenic strains
---Half of C. diff isolates are non-toxigenic
--PCR / NAAT
--Detects tcdA/tcdB genes, mRNA for the toxins
---Detects presence of toxigenic strains of C. diff
-mRNA doesn't necessarily imply active infection
--EIA / ELISA
---Detects toxin in stool
---LOw sensitivity (0.73-0.87)
-Multistep algorithms, there are dozens
--EIA for GDH / Toxin A/B
--Both positive = C. diff
-Both negative = NO C. diff
--Mixed results, use PCR for tedB as tiebreaker
-Toxin EIA 1 (Meridian), higher PPV, lower NPV
--Toxin EIA 2 (TechLab), lower PPV, higher NPV
-Highest NPV (99.8%) GDH EIA + NAAT
---Highest PPV (93.5%) Toxin EIA 1 + NAAT
TREATMENT
-First line treatment
-PO Vancomycin (78.5% success rate, 25,3% recurrence rate)
-PO Metronidazole (66,3% success rate, 47% recurrence rate), recent strains have
higher MIC
-Disease stratification
-WBC (15), Cr (1.5% baseline), recurrence, hypotension, ileus, megacolon
-Mild = Metronidazole, preferred for cost and non-inferiority in mild disease
-Severe/Complicated = Vancomycin
-Recurrent = Metro or Vanco for first recurrence, Vanco for subsequent
-Nener treatments
- -Fidazomicin (87.7% success rate vs. 86.8% for vanco, 15.4% recurrence rate)
-=-Expensive
_-Fecal microbiota transplant (83-94% success rate for recurrent COL)
Fecal microbiota transplantation restores gut microbiota diversity, with the
instillation of donor stool into the gastrointestinal tract of an infected patient,
This procedure has had good clinical response without reports of adverse events, for
refractory or recurrent COI. The first systematic revien was published in 2911 and
included 317 patients with recurrent COI treated with fecal microbiota
transplantation via enema, nasojejunal-tube/gastroscope or colonoscopy. Clinical
resolution occurred in 92% of patients (89% after a single treatment), without
serious adverse effects. A recent revien of 536 patients reported a 27% clinical
response rate.
A randomized trial of fecal microbiota transplantation demonstrated symptom
resolution in 94% of patients who received vancomycin for s days followed by either
one or two treatments with fecal microbiota transplantation, versus 31% in those
receiving vancomycin alone for 14 days, and 23% for those receiving vanconycin for
14 days plus bowel lavage. This study was stopped early after interim analyses
demonstrated superiority of fecal microbiota transplantation, Among 18 patients in
the other treatment groups who received subsequent fecal microbiota transplantation
83% had symptom resolution
Natasha Bagdasarian et al.
Published in JAMA 2019.
Systematic review of 116 included studies between 1978 and 2014.
DIAGNOSIS
Laboratory testing cannot distinguish between asymptomatic colonization and
¿Eyed frat' cuitisten a forfindsfficile. The best test performance characteristics
-Diagnostic criteria
--Diarrhea
-Positive stool test for toxigenic C. diff or toxins or pseudomembranous colitis
-Diagnostic approaches
-Toxigenic Culture (TC) and/or Cell Cytotoxicity Assay (CCA)
---Anaerobic culture for 24-48 hrs followed by colony selection and culture with
human cells to test for cell cytotoxicity which takes an additional 24-48 hours.
-Gold standard
--- Time consuming and difficult, up to 5 days
---Detects a little as 3 picograms of toxin
-Stool antigen looks for Glutamate dehydrogenase (COH) via ELISA (SIA)
---Does not distinguish between toxigenic and non-toxigenic strains
---Half of C. diff isolates are non-toxigenic
--PCR / NAAT
--Detects tcdA/tcdB genes, mRNA for the toxins
---Detects presence of toxigenic strains of C. diff
-mRNA doesn't necessarily imply active infection
--EIA / ELISA
---Detects toxin in stool
---LOw sensitivity (0.73-0.87)
-Multistep algorithms, there are dozens
--EIA for GDH / Toxin A/B
--Both positive = C. diff
-Both negative = NO C. diff
--Mixed results, use PCR for tedB as tiebreaker
-Toxin EIA 1 (Meridian), higher PPV, lower NPV
--Toxin EIA 2 (TechLab), lower PPV, higher NPV
-Highest NPV (99.8%) GDH EIA + NAAT
---Highest PPV (93.5%) Toxin EIA 1 + NAAT
TREATMENT
-First line treatment
-PO Vancomycin (78.5% success rate, 25,3% recurrence rate)
-PO Metronidazole (66,3% success rate, 47% recurrence rate), recent strains have
higher MIC
-Disease stratification
-WBC (15), Cr (1.5% baseline), recurrence, hypotension, ileus, megacolon
-Mild = Metronidazole, preferred for cost and non-inferiority in mild disease
-Severe/Complicated = Vancomycin
-Recurrent = Metro or Vanco for first recurrence, Vanco for subsequent
-Nener treatments
- -Fidazomicin (87.7% success rate vs. 86.8% for vanco, 15.4% recurrence rate)
-=-Expensive
_-Fecal microbiota transplant (83-94% success rate for recurrent COL)
Fecal microbiota transplantation restores gut microbiota diversity, with the
instillation of donor stool into the gastrointestinal tract of an infected patient,
This procedure has had good clinical response without reports of adverse events, for
refractory or recurrent COI. The first systematic revien was published in 2911 and
included 317 patients with recurrent COI treated with fecal microbiota
transplantation via enema, nasojejunal-tube/gastroscope or colonoscopy. Clinical
resolution occurred in 92% of patients (89% after a single treatment), without
serious adverse effects. A recent revien of 536 patients reported a 27% clinical
response rate.
A randomized trial of fecal microbiota transplantation demonstrated symptom
resolution in 94% of patients who received vancomycin for s days followed by either
one or two treatments with fecal microbiota transplantation, versus 31% in those
receiving vancomycin alone for 14 days, and 23% for those receiving vanconycin for
14 days plus bowel lavage. This study was stopped early after interim analyses
demonstrated superiority of fecal microbiota transplantation, Among 18 patients in
the other treatment groups who received subsequent fecal microbiota transplantation
83% had symptom resolution