C. difficile Review: Early Diagnosis, Prevention, and Treatment
An update on the 2011 comparative effectiveness review on the early diagnosis, prevention, and treatment of Clostridium difficile was released to aid healthcare professionals, patients, policymakers, and others in well-informed decision-making.Researchers aimed to highlight the differences in accuracy of diagnostic tests and the effects of interventions to prevent and treat C. diff infection (CDI) in adults. Data was analyzed from searches in Medline, the Cochrane Clinical Trials Registry, and Embase from 2010–April 2015 as well as referenced studies and recent systematic reviews.Studies for inclusion looked at sensitivity and specificity for diagnostic tests in at-risk patients for CDI. Randomized controlled studies or high-quality cohort studies that evaluated adults with CDI or suspected CDI for treatment interventions were included. A total of 37 diagnostic studies and 56 prevention or treatment intervention studies were included for the review update.
High-strength evidence indicated that nucleic amplification tests were sensitive and specific for CDI when cultures were used as the reference standard. High-strength evidence also showed that in treating CDI, vancomycin was more effective than metronidazole and the effect did not vary by severity (moderate-strength).
Fidaxomicin remained noninferior to vancomycin for initial CDI cure (moderate-strength) but proved superior in the prevention of recurrent CDI (high-strength).
Low-strength evidence suggested that fecal microbiota transplantation (FMT) may exert a significant effect on reducing recurrent CDI. In addition, lactobaccilus strains and multiorganism probiotic can also reduce recurrent CDI. Saccharomyces boulardii, however, did not prove more effective than placebo in the prevention of recurrent CDI.
The review was prepared by the Minnesota Evidence-based Practice Center for the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services.
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