The Resource Early diagnosis, prevention, and treatment of clostridium difficile : update, prepared for Agency for Healthcare Research and Quality ; prepared by Minnesota Evidence-based Practice Center ; investigators, Mary Butler, Andrew Olson, Dimitri Drekonja, Aasma Shaukat, Natalie Schwehr, Nathan Shippee, Timothy J Wilt

Early diagnosis, prevention, and treatment of clostridium difficile : update, prepared for Agency for Healthcare Research and Quality ; prepared by Minnesota Evidence-based Practice Center ; investigators, Mary Butler, Andrew Olson, Dimitri Drekonja, Aasma Shaukat, Natalie Schwehr, Nathan Shippee, Timothy J Wilt

Label
Early diagnosis, prevention, and treatment of clostridium difficile : update
Title
Early diagnosis, prevention, and treatment of clostridium difficile
Title remainder
update
Statement of responsibility
prepared for Agency for Healthcare Research and Quality ; prepared by Minnesota Evidence-based Practice Center ; investigators, Mary Butler, Andrew Olson, Dimitri Drekonja, Aasma Shaukat, Natalie Schwehr, Nathan Shippee, Timothy J Wilt
Title variation
Effective health care program
Creator
Contributor
Author
Issuing body
Subject
Genre
Language
eng
Summary
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
Member of
Cataloging source
MMU
http://library.link/vocab/creatorDate
active 2008
http://library.link/vocab/creatorName
Butler, Mary
Funding information
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, 5600 Fishers Lane, Rockville, MD 20857; Contract No. 290-2012-00016-I. Prepared by: Minnesota Evidence-based Practice Center, Minneapolis, MN
Government publication
federal national government publication
Illustrations
illustrations
Index
no index present
Literary form
non fiction
Nature of contents
  • dictionaries
  • bibliography
  • surveys of literature
NLM call number
WI 420
http://library.link/vocab/relatedWorkOrContributorName
  • Olson, Andrew
  • Drekonja, Dimitri
  • Shaukat, Aasma
  • Schwehr, Natalie
  • Shippee, Nathan
  • Wilt, Timothy J.
  • Minnesota Evidence-based Practice Center
  • United States
  • Effective Health Care Program (U.S.)
Series statement
  • Comparative effectiveness review
  • AHRQ publication
Series volume
  • number 172
  • no. 16-EHC012-EF
http://library.link/vocab/subjectName
  • Enterocolitis, Pseudomembranous
  • Enterocolitis, Pseudomembranous
  • Enterocolitis, Pseudomembranous
  • Early Diagnosis
  • Comparative Effectiveness Research
http://bibfra.me/vocab/relation/supportingbody
RzTDSdffmEM
Label
Early diagnosis, prevention, and treatment of clostridium difficile : update, prepared for Agency for Healthcare Research and Quality ; prepared by Minnesota Evidence-based Practice Center ; investigators, Mary Butler, Andrew Olson, Dimitri Drekonja, Aasma Shaukat, Natalie Schwehr, Nathan Shippee, Timothy J Wilt
Instantiates
Publication
Note
"March 2016."
Bibliography note
Includes bibliographical references
Carrier category
online resource
Carrier category code
cr
Carrier MARC source
rdacarrier
Content category
  • text
  • still image
Content type code
  • txt
  • sti
Content type MARC source
  • rdacontent
  • rdacontent
Control code
957557722
Extent
1 online resource (various pagings)
Form of item
online
Media category
computer
Media MARC source
rdamedia
Media type code
c
Other physical details
illustrations
Specific material designation
remote
System control number
(OCoLC)957557722
Label
Early diagnosis, prevention, and treatment of clostridium difficile : update, prepared for Agency for Healthcare Research and Quality ; prepared by Minnesota Evidence-based Practice Center ; investigators, Mary Butler, Andrew Olson, Dimitri Drekonja, Aasma Shaukat, Natalie Schwehr, Nathan Shippee, Timothy J Wilt
Publication
Note
"March 2016."
Bibliography note
Includes bibliographical references
Carrier category
online resource
Carrier category code
cr
Carrier MARC source
rdacarrier
Content category
  • text
  • still image
Content type code
  • txt
  • sti
Content type MARC source
  • rdacontent
  • rdacontent
Control code
957557722
Extent
1 online resource (various pagings)
Form of item
online
Media category
computer
Media MARC source
rdamedia
Media type code
c
Other physical details
illustrations
Specific material designation
remote
System control number
(OCoLC)957557722

Library Locations

  • St. Louis Mercantile LibraryBorrow it
    1 University Blvd, St. Louis, MO, 63121, US
    38.710138 -90.311107
  • Thomas Jefferson LibraryBorrow it
    1 University Blvd, St. Louis, MO, 63121, US
    38.710138 -90.311107
  • University ArchivesBorrow it
    703 Lewis Hall, Columbia, MO, 65211, US
  • University of Missouri-St. Louis Libraries DepositoryBorrow it
    2908 Lemone Blvd, Columbia, MO, 65201, US
    38.919360 -92.291620
  • University of Missouri-St. Louis Libraries DepositoryBorrow it
    2908 Lemone Blvd, Columbia, MO, 65201, US
    38.919360 -92.291620
  • Ward E Barnes Education LibraryBorrow it
    8001 Natural Bridge Rd, St. Louis, MO, 63121, US
    38.707079 -90.311355
Processing Feedback ...