scholarly journals New concepts in C. difficile management

2019 ◽  
Vol 131 (1) ◽  
pp. 109-118
Author(s):  
Y R Mahida

Abstract Background Clostridium difficile infection is transmitted via spores, and the disease is mediated via secreted toxins. It represents a significant healthcare problem, and clinical presentation can range from asymptomatic carriage to life-threatening pseudomembranous colitis. Sources of data publications in the field, with a focus on recent developments and concepts. Areas of agreement infection control measures, antibiotic stewardship and current management of the initial episode of C. difficile infection. Areas of controversy selection and sequence of interventions for the management of recurrent C. difficile infection; management of persistent carriers of toxigenic C. difficile in patients at high risk of subsequent C. difficile infection. Growing points use of faecal microbiota transplantation for recurrent C. difficile infection. Areas timely for developing research role of specific microbiota-mediated interventions and vaccination in the treatment and prevention of C. difficile infection.

2018 ◽  
pp. 105-114
Author(s):  
Abdullah Jibawi ◽  
Mohamed Baguneid ◽  
Arnab Bhowmick

It’s important to be aware of healing process, associated comorbidities, and the role of nutrition in wound care management. Assessment of the amount and type of wound exudate plays an important role in deciding the type of dressing used. Infection or underlying osteomyelitis needs careful assessment, further investigation, and administration of systemic/oral anti-microbial therapy. Early use of non-surgical or surgical debridement is necessary to speed up the healing process. Diagnostic criteria of surgical site infection are increasingly used in postoperative wounds in hospitals for audit of infection control measures. No one type of dressing appears superior over other. Dressings should be cost effective, acceptable to the patients, and easy to use. In addition, in recent decades newer non-surgical debriding method, e.g. larvae therapy and negative pressure wound therapy, are increasingly being used and supported by recent NICE guidelines, especially in diabetic foot care.


2012 ◽  
Vol 27 (2_suppl) ◽  
pp. 53-60 ◽  
Author(s):  
G Radhakrishna ◽  
D Berridge

The relationship between cancer and venothromboembolic events is a complex, multifactorial process which is still not fully understood and therefore the use of current generic guidelines may be inadequate. Current management of cancer-related VTE may be suboptimal because of the lack of cancer-specific studies into the role of primary prophylaxis in both ambulant and non-ambulant cancer patients. Further research into developing cancer-specific risk assessment tools and the choice, dose and duration of prophylaxis is required. The management of confirmed symptomatic VTE in cancer patients is outlined but certain controversies remain. Areas for further research include the management of asymptomatic unsuspected VTE events, recurrent VTE events on treatment and the role of IVC filters and other treatment options are required. This paper attempts to cover some of the recent developments and areas of uncertainty surrounding the management of cancer-related VTE.


2020 ◽  
Author(s):  
Dinesh Aggarwal ◽  
Richard Myers ◽  
William L. Hamilton ◽  
Tehmina Bharucha ◽  
Niamh Tumelty ◽  
...  

A review was undertaken of all genomic epidemiology studies on COVID-19 in long term care facilities (LTCF) that have been published to date. It was found that staff and residents were usually infected with identical, or near identical, SARS-CoV-2 genomes. Outbreaks usually involved one predominant lineage, and the same lineages persisted in LTCFs despite infection control measures. Outbreaks were most commonly due to single or few introductions followed by spread rather than a series of seeding events from the community into LTCFs. Sequencing of samples taken consecutively from the same cases showed persistence of the same genome sequence indicating that the sequencing technique was robust over time. When combined with local epidemiology, genomics facilitated likely transmission sources to be better characterised. Transmission between LTCFs was detected in multiple studies. The mortality rate amongst residents was high in all cases, regardless of the lineage. Bioinformatics methods were inadequate in one third of the studies reviewed, and reproducing the analyses was difficult as sequencing data were not available in many cases.


2021 ◽  
Vol 25 (2) ◽  
pp. 126-133
Author(s):  
G. Sotgiu ◽  
S. Rosales-Klintz ◽  
R. Centis ◽  
L. D'Ambrosio ◽  
R. Verduin ◽  
...  

BACKGROUND: Essential TB care in the European Union/European Economic Area (EU/EEA) comprises 21 standards for the diagnosis, treatment and prevention of TB that constitute the European Union Standards for Tuberculosis Care (ESTC).METHODS: In 2017, we conducted an audit on TB management and infection control measures against the ESTC standards. TB reference centres in five EU/EEA countries were purposely selected to represent the heterogeneous European TB burden and examine geographic variability.RESULTS: Data from 122 patients, diagnosed between 2012 and 2015 with multidrug-resistant TB (n = 49), extensively drug‐resistant TB (XDR‐TB) (n = 11), pre‐XDR‐TB (n = 29) and drug‐susceptible TB (n = 33), showed that TB diagnosis and treatment practices were in general in agreement with the ESTC.CONCLUSION: Overall, TB management and infection control practices were in agreement with the ESTC in the selected EU/EEA reference centres. Areas for improvement include strengthening of integrated care services and further implementation of patient‐centred approaches.


2007 ◽  
Vol 28 (9) ◽  
pp. 1077-1084 ◽  
Author(s):  
Charles S. Bryan ◽  
Theresa J. Call ◽  
Kevin C. Elliott

Recent developments that are relevant to the ethics of infection control include the patient safety movement, the appearance of new diseases (notably, severe acute respiratory syndrome) that pose threats to healthcare workers, data confirming the suspicion that infection control measures such as isolation may compromise patient care, and, in philosophy, renewed interest in virtue ethics and communitarianism. We review general ethical frameworks and relevant vocabulary for infection control practitioners and hospital epidemiologists. Frameworks for the ethics of infection control resemble those of public health more than those of clinical medicine but embrace elements of both. The optimum framework, we suggest, takes into account a virtue-based communitarianism. The virtue ethics movement stresses the need to consider not only rules and outcomes but also the character of the individual(s) involved. Communitarianism emphasizes the well-being and values of local communities, best determined by shared, democratic decision making among stakeholders. Brief discussions of 15 consecutive cases illustrate the extent to which the daily practice of infection control poses problems heavily freighted with ethical overtones.


2014 ◽  
Vol 100 (1) ◽  
pp. 68-72 ◽  
Author(s):  
Katherine Anagnostou ◽  
Andrew Clark

Peanut allergy is common and can be a cause of severe, life-threatening reactions. It is rarely outgrown like other food allergies such as egg and milk. Measures aiming to reduce its prevalence via maternal avoidance during pregnancy and lactation, or delayed introduction into the diet, have failed to show any benefit. Peanut allergy has a significant effect on the quality of life of sufferers and their families due to dietary and social restrictions, but mainly stemming from fear of accidental peanut ingestion. The current management consists of strict avoidance, education and provision of emergency medication. Families find avoidance challenging as peanut is hidden in various food products. Despite the fact that food labelling has improved, with a legal obligation to declare certain food allergens (including nuts) in prepacked products, it still causes confusion and does not extend to cross-contamination. In an effort to address issues of safety at school, a lot of work has been undertaken to better care for peanut-allergic children in that environment. This includes training of school staff on how to recognise and treat allergic reactions promptly. Recent developments in the management of peanut allergy, such as immunotherapy, have shown some promise as an active form of treatment, but larger studies are required to further investigate safety and efficacy.


2009 ◽  
Vol 7 (3) ◽  
pp. 469-477 ◽  
Author(s):  
Steven L. Percival ◽  
John G. Thomas

Documented evidence relating to the survival of Helicobacter pylori outside the gastric niche is extremely limited. To date the primary transmission routes of H. pylori have yet to be confirmed and when this is achieved preventive infection control measures can be implemented to reduce and ultimately prevent human infection from this pathogen. There is mounting evidence which suggests that the prevalence of H. pylori infection has a strong correlation with access to clean water, suggesting a transmission route to the host. However, there are no established culture methods for the detection of viable H. pylori in the environment, in particular drinking water supplies, preventing the development of true epidemiological and risk assessments. The aim of this review is to highlight the available data to date that suggests drinking water and possible survival in biofilms as a probable transmission mode for H. pylori.


1984 ◽  
Vol 5 (7) ◽  
pp. 326-331 ◽  
Author(s):  
Allyn K. Nakashima ◽  
James R. Allen ◽  
William J. Martone ◽  
Brian D. Plikaytis ◽  
Beth Storer ◽  
...  

AbstractFrom September 14, 1981 to February 28, 1982, an epidemic of bullous impetigo caused by a penicillin/tetracycline resistant strain of Staphylococcus aureus, phage type 3A/3C, occurred in a newborn nursery in Louisville, Kentucky. Twenty of 1,181 (1.7%) infants at risk developed disease during the six-month epidemic period. Clinically all case-infants had bullous impetigo skin lesions. One infant developed staphylococcal septicemia. No infant died. An epidemiologic investigation identified a nurse as having significantly greater contact with case-infants than control-infants (p=0.0013). She was also found to be a nasal carrier of the epidemic strain. Infection control measures appeared to decrease infant-to-infant transmission via the hands of non-colonized nurses, but did not affect transmission from the nurse carrying the epidemic strain to infants. No cases of bullous impetigo have occurred since this nurse was temporarily removed from the nursery for treatment.


2000 ◽  
Vol 45 (2) ◽  
pp. 107-116 ◽  
Author(s):  
B. Souweine ◽  
O. Traore ◽  
B. Aublet-Cuvelier ◽  
L. Bret ◽  
J. Sirot ◽  
...  

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