Bethesda, MD (April 1, 2009) – Doctors have developed and validated a clinical prediction rule for recurrent Clostridium difficile (C. difficile) infection that was simple, reliable and accurate, and can be used to identify high-risk patients most likely to benefit from measures to prevent recurrence. Their findings appear in a new study in Gastroenterology, the official journal of the American Gastroenterological Association (AGA) Institute.
"This rule is valuable in clinical practice as it defines a high-risk population in whom awareness of the risk can facilitate more prompt recognition, diagnosis and treatment of recurrent C. difficile," said Ciaran P. Kelly, MD, of Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School and lead author of the study. "These patients are also most likely to benefit from interventions to prevent recurrence, such as infection control precautions, prudent use of antibiotics, prolongation of metronidazole or vancomycin therapy, and use of probiotics or other prophylactic measures."
The prevention of recurrent C. difficile is a substantial therapeutic challenge. This disorder has become the leading known cause of hospital-acquired infectious diarrhea in the developed world. Despite advances in knowledge of the pathogenesis of C. difficile, the organism continues to afflict millions of patients every year and is associated with increasing morbidity and death.
At BIDMC between January and May 1998, a research team prospectively studied 63 hospitalized patients with C. difficile and used the data to develop a clinical prediction rule for recurrent C. difficile (derivation cohort). In the current study, an independent cohort of patients was investigated under a protocol almost identical to that used in the previous study. All adult patients with C. difficile hospitalized at BIDMC between December 2004 and May 2006 were eligible for study entry. Data from this second cohort were used to evaluate the performance of the prediction rule (validation cohort).
A clinical prediction rule is used by clinicians to identify symptoms or diagnoses that can best predict a patient's chance for disease or a negative clinical outcome. Researchers used a combination of age >65 years, Horn's index severe or fulminant, and additional antibiotic use, which accurately predicted patients most likely to suffer recurrence. The clinical rule accurately identified groups of patients with increasing probability of recurrent C. difficile with 77.3 percent diagnostic accuracy.
"Approximately 20 percent of individuals experience C. difficile recurrence despite successful treatment of the initial episode, and the risk may be as high as 65 percent for those with a prior history," added Dr. Kelly. "This rule will be of great value in selecting high-risk patients for clinical trials of novel agents to prevent recurrent C. difficile in the future."
About the AGA Institute
The American Gastroenterological Association (AGA) is dedicated to the mission of advancing the science and practice of gastroenterology. Founded in 1897, the AGA is one of the oldest medical-specialty societies in the U.S. Comprised of two non-profit organizations—the AGA and the AGA Institute—our more than 17,000 members include physicians and scientists who research, diagnose and treat disorders of the gastrointestinal tract and liver. The AGA, a 501(c6) organization, administers all membership and public policy activities, while the AGA Institute, a 501(c3) organization, runs the organization's practice, research and educational programs. On a monthly basis, the AGA Institute publishes two highly respected journals, Gastroenterology and Clinical Gastroenterology and Hepatology. The organization's annual meeting is Digestive Disease Week®, which is held each May and is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. For more information, please visit www.gastro.org.
Gastroenterology, the official journal of the AGA Institute, is the most prominent scientific journal in the specialty and is in the top 1 percent of indexed medical journals internationally. The journal publishes clinical and basic science studies of all aspects of the digestive system, including the liver and pancreas, as well as nutrition. The journal is abstracted and indexed in Biological Abstracts, CABS, Chemical Abstracts, Current Contents, Excerpta Medica, Index Medicus, Nutrition Abstracts and Science Citation Index. For more information, visit www.gastrojournal.org.
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