Posts filed under ‘Infecciones gastrointestinales’

Real-Time Electronic Tracking of Diarrheal Episodes and Laxative Therapy Enables Verification of Clostridium difficile Clinical Testing Criteria and Reduction of Clostridium difficile Infection Rates

Journal of Clinical Microbiology May 2017 V.55 N.5 P.1276-1284

Cynthia Y. Truong, Saurabh Gombar, Richard Wilson, Gopalakrishnan Sundararajan, Natasa Tekic, Marisa Holubar, John Shepard, Alexandra Madison, Lucy Tompkins, Neil Shah, Stan Deresinski, Lee F. Schroeder, and Niaz Banaei

aDepartment of Pathology, Stanford University School of Medicine, Stanford, California, USA

bDigital Solutions, Stanford Health Care, Stanford, California, USA

cDivision of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA

dInfection Control and Prevention, Stanford Health Care, Stanford, California, USA

eStanford Antimicrobial Safety and Sustainability, Stanford Health Care, Stanford, California, USA

fDepartment of Pathology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA

gClinical Microbiology Laboratory, Stanford Health Care, Stanford, California, USA

Health care-onset health care facility-associated Clostridium difficile infection (HO-CDI) is overdiagnosed for several reasons, including the high prevalence of C. difficile colonization and the inability of hospitals to limit testing to patients with clinically significant diarrhea. We conducted a quasiexperimental study from 22 June 2015 to 30 June 2016 on consecutive inpatients with C. difficile test orders at an academic hospital. Real-time electronic patient data tracking was used by the laboratory to enforce testing criteria (defined as the presence of diarrhea [≥3 unformed stools in 24 h] and absence of laxative intake in the prior 48 h). Outcome measures included C. difficile test utilization, HO-CDI incidence, oral vancomycin utilization, and clinical complications. During the intervention, 7.1% (164) and 9.1% (211) of 2,321 C. difficile test orders were canceled due to absence of diarrhea and receipt of laxative therapy, respectively. C. difficile test utilization decreased upon implementation from an average of 208.8 tests to 143.0 tests per 10,000 patient-days (P < 0.001). HO-CDI incidence rate decreased from an average of 13.0 cases to 9.7 cases per 10,000 patient-days (P = 0.008). Oral vancomycin days of therapy decreased from an average of 13.8 days to 9.4 days per 1,000 patient-days (P = 0.009). Clinical complication rates were not significantly different in patients with 375 canceled orders compared with 869 episodes with diarrhea but negative C. difficile results. Real-time electronic clinical data tracking is an effective tool for verification of C. difficile clinical testing criteria and safe reduction of inflated HO-CDI rates.

PDF

http://jcm.asm.org/content/55/5/1276.full.pdf+html

May 9, 2017 at 8:23 am

Commentaries – Strategies for Optimizing the Diagnostic Predictive Value of Clostridium difficile Molecular Diagnostics

Journal of Clinical Microbiology May 2017 V.55 N.5 P.1244-1248

Larry K. Kociolek

Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Division of Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA

Because nucleic acid amplification tests (NAATs) do not distinguish Clostridium difficile infection (CDI) and asymptomatic C. difficile carriage, the diagnostic predictive value of NAATs is limited when used in patients with a low probability of CDI. In this issue of the Journal of Clinical Microbiology, Truong et al. (J. Clin. Microbiol., 55:1276–1284, 2017, https://doi.org/10.1128/JCM.02319-16) report significant reductions in hospital-onset CDI and oral vancomycin utilization at their institution following implementation of a novel intervention that leveraged their clinical bioinformatics resources to prevent C. difficile testing of stools from patients without clinically significant diarrhea and in patients with recent laxative use….

PDF

http://jcm.asm.org/content/55/5/1244.full.pdf+html

May 9, 2017 at 8:22 am

CMV infection complicating the diagnosis of Crohn’s disease in an immunocompetent patient.

BMJ Case Rep. 2012 May 8;2012. pii: bcr1120115254. doi: 10.1136/bcr.11.2011.5254.

Shahani L1.

1Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA. lokesh83@hotmail.com

Abstract

Cytomegalovirus (CMV) affects the gastrointestinal tract commonly; however CMV colitis is uncommon in patients who are not severely immunocompromised.

The author reports a 51-year-old Caucasian female who was admitted to the hospital with exacerbation of her chronic diarrhoea. CAT scan of the abdomen and pelvis showed thickening of the wall of the terminal ileum with inflammatory stranding and follow-up colonoscopy showed extensive circumferential ulceration in the terminal ileum.

Biopsies confirmed diagnosis of CMV infection and the patient was started on appropriate antimicrobial agents. CMV viremia showed response to the medication; however the patient’s intestinal symptoms failed to improve.

Nodular lesions consistent with erythema nodusum were noticed and promethus test was consistent with Crohn’s disease.

The patient showed good response to immunosuppressive therapy. CMV infections are known to exacerbate symptoms of inflammatory bowel disease and hence Crohn’s disease should be suspected in an immunocompetent patient presenting with CMV ileitis.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3351665/pdf/bcr.11.2011.5254.pdf

February 9, 2017 at 2:51 pm

Clinical significance of cytomegalovirus infection in patients with inflammatory bowel disease.

World J Gastroenterol. 2013 Jan 7;19(1):17-25.

Garrido E1, Carrera E, Manzano R, Lopez-Sanroman A.

Author information

1Inflammatory Bowel Disease Clinic, Department of Gastroenterology, University Hospital Ramón y Cajal, 28034 Madrid, Spain. elenagarridogomez@hotmail.com

Abstract

Cytomegalovirus (CMV) infection is common in humans. The virus then enters a “latency phase” and can reactivate to different stimuli such as immunosuppression. The clinical significance of CMV infection in inflammatory bowel disease is different in Crohn’s disease (CD) and ulcerative colitis (UC).

CMV does not interfere in the clinical course of CD. However, CMV reactivation is frequent in severe or steroid-resistant UC. It is not known whether the virus exacerbates the disease or simply appears as a bystander of a severe disease. Different methods are used to diagnose CMV colitis.

Diagnosis is classically based on histopathological identification of viral-infected cells or CMV antigens in biopsied tissues using haematoxylin-eosin or immunohistochemistry, other tests on blood or tissue samples are currently being investigated.

Polymerase chain reaction performed in colonic mucosa has a high sensitivity and a positive result could be associated with a worse prognosis disease; further studies are needed to determine the most appropriate strategy with positive CMV-DNA in colonic mucosa. Specific endoscopic features have not been described in active UC and CMV infection.

CMV colitis is usually treated with ganciclovir for several weeks, there are different opinions about whether or not to stop immunosuppressive therapy. Other antiviral drugs may be used. Multicenter controlled studies would needed to determine which subgroup of UC patients would benefit from early antiviral treatment.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3545225/pdf/WJG-19-17.pdf

February 9, 2017 at 2:49 pm

Cytomegalovirus infection in inflammatory bowel disease is not associated with worsening of intestinal inflammatory activity.

PLoS One. 2014 Nov 11;9(11):e111574.

do Carmo AM1, Santos FM1, Ortiz-Agostinho CL1, Nishitokukado I1, Frota CS1, Gomes FU1, Leite AZ1, Pannuti CS2, Boas LS3, Teixeira MG4, Sipahi AM1.

Author information

1Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – LIM 07, São Paulo, São Paulo, Brazil.

2Instituto de Medicina Tropical e Departamento de Doenças Infecciosas e Parasitarias (LIM-HC) da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil.

3Instituto de Medicina Tropical e Hospital das Clínicas da Faculdade de Medicina (LIM-HC), Universidade de São Paulo, São Paulo, São Paulo, Brazil.

4Departamento de Cirurgia do Serviço de Cirurgia do Cólon Reto e Ânus, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil.

Erratum in

Correction: Cytomegalovirus Infection in Inflammatory Bowel Disease Is Not Associated with Worsening of Intestinal Inflammatory Activity. [PLoS One. 2015]

Abstract

BACKGROUND:

Cytomegalovirus is highly prevalent virus and usually occurs in immunocompromised patients. The pathophysiology and treatment of inflammatory bowel disease often induce a state of immunosuppression. Because this, there are still doubts and controversies about the relationship between inflammatory bowel disease and cytomegalovirus.

AIM:

Evaluate the frequency of cytomegalovirus in patients with inflammatory bowel disease and identify correlations.

METHODS:

Patients with inflammatory bowel disease underwent an interview, review of records and collection of blood and fecal samples. The search for cytomegalovirus was performed by IgG and IgM blood serology, by real-time PCR in the blood and by qualitative PCR in feces. Results were correlated with red blood cell levels, C-reactive protein levels, erythrocyte sedimentation rates and fecal calprotectin levels for each patient.

RESULTS:

Among the 400 eligible patients, 249 had Crohn’s disease, and 151 had ulcerative colitis. In the group of Crohn’s disease, 67 of the patients had moderate or severe disease, but 126 patients presented with active disease, based on the evaluation of the fecal calprotectin. In patients with ulcerative colitis, only 21 patients had moderate disease, but 76 patients presented with active disease, based on the evaluation of the fecal calprotectin. A large majority of patients had positive CMV IgG. Overall, 10 patients had positive CMV IgM, and 9 patients had a positive qualitative detection of CMV DNA by PCR in the feces. All 400 patients returned negative results after the quantitative detection of CMV DNA in blood by real-time PCR. Analyzing the 19 patients with active infections, we only found that such an association occurred with the use of combined therapy (anti-TNF-alpha + azathioprine).

CONCLUSION:

The findings show that latent cytomegalovirus infections are frequent and active cytomegalovirus infection is rare. We did not find any association between an active infection of CMV and inflammatory bowel disease activity

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4227676/pdf/pone.0111574.pdf

 

February 9, 2017 at 2:47 pm

Cytomegalovirus colitis with common variable immunodeficiency and Crohn’s disease.

Case Rep Med. 2015;2015:348204.

Ünal B1, Başsorgun Cİ1, Çil Gönülcü S1, Uçar A1, Çelik F1, Elpek GÖ1.

Author information

1Department of Pathology, School of Medicine, Akdeniz University, Turkey.

Abstract

Here we present an eleven-year-old male patient who had been diagnosed with common variable immunodeficiency (CVID) three years ago due to recurrent sinopulmonary infections. Two years later he had been diagnosed with Crohn’s disease (CD) due to diarrhea episodes which were unresponsive to the treatment.

Depending on the active gastrointestinal bleeding and perforation he underwent total colectomy. Despite immunoglobulin and antiviral therapies, general condition of patient deteriorated and he died in the postoperative seventh day.

Laboratory analysis was seronegative. CMV inclusion containing cells were detected in postmortem biopsies taken from liver, lungs, and lymph nodes.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4352901/pdf/CRIM2015-348204.pdf

February 9, 2017 at 2:45 pm

Zinplava Tackles Toxins Of Hard-to-Treat C. Difficile.

Manag Care. 2017 Jan;26(1):30-31.

Morrow T.

Abstract

Merck has recently received FDA approval for bezlotoxumab (Zinplava), as a treatment to reduce recurrence of C. diffcile in patients 18 years of age or older who are receiving antibiotic treatment for the infection and for whom there is a high risk of recurrence.

FULL TEXT

https://www.managedcaremag.com/linkout/2017/1/30

February 7, 2017 at 3:41 pm

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