Antimicrobial therapy ofClostridium difficileinfection. Systematic literature review and meta-analysis

2013 ◽  
Vol 154 (23) ◽  
pp. 890-899 ◽  
Author(s):  
Valentin Brodszky ◽  
László Gulácsi ◽  
Endre Ludwig ◽  
Gyula Prinz ◽  
János Banai ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Clinical Cure ◽  
Meta Analysis ◽  
Scientific Evidence ◽  
Pharmaceutical Products ◽  
Efficacy And Safety ◽  
The Past ◽  
Significant Difference

Introduction:Clostridium difficile is the leading cause of antibiotic associated infectious nosocomial diarrhoea. Limited number of new pharmaceutical products have been developed and registered in the past decades for the treatment of Clostridium difficile infection. The available scientific evidence is limited and hardly comparable. Aim: To analyse the clinical efficacy and safety of metronidazole, vancomycin and fidaxomicin in the therapy of Clostridium difficile infection. Methods: Systematic review and meta-analysis of the literature data. Results: Meta-analysis of literature data showed no significant difference between these antibiotics in clinical cure endpoint (odss ratios: fidaxomicin vs. vancomycin 1.19; vancomycin vs. metronidazol 1.69 and fidaxomicin vs. metronidazol 2.00). However, fidaxomicin therapy was significantly more effective than vancomicin and metronidazol in endpoints of recurrence and global cure (odds ratios: fidaxomicin vs. vancomycin 0.47; vancomycin vs. metronidazol 0.91 és fidaxomicin vs. metronidazol 0.43). There was no significant difference between fidaxomicin, vancomycin and metronidazole in safety endpoints. Conclusions: Each antibiotic similarly improved clinical cure. Fidaxomicin was the most effective therapeutic alternative in lowering the rate of recurrent Clostridium difficile infections. Orv. Hetil., 2013, 154, 890–899.

scholarly journals Prevalence and Clinical Outcomes of Clostridium difficile Infection in the Intensive Care Unit: A Systematic Review and Meta-Analysis

2015 ◽  
Vol 3 (1) ◽  
Author(s):  
Styliani Karanika ◽  
Suresh Paudel ◽  
Fainareti N. Zervou ◽  
Christos Grigoras ◽  
Ioannis M. Zacharioudakis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Clostridium Difficile ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Clostridium Difficile Infection ◽  
Meta Analysis ◽  
Icu Patients ◽  
Significant Difference

Abstract Background.  Intensive care unit (ICU) patients are at higher risk for Clostridium difficile infection (CDI). Methods. We performed a systematic review and meta-analysis of published studies from 1983 to 2015 using the PubMed, EMBASE, and Google Scholar databases to study the prevalence and outcomes of CDI in this patient population. Among the 9146 articles retrieved from the studies, 22 articles, which included a total of 80 835 ICU patients, were included in our final analysis. Results.  The prevalence of CDI among ICU patients was 2% (95% confidence interval [CI], 1%–2%), and among diarrheic ICU patients the prevalence was 11% (95% CI, 6%–17%). Among CDI patients, 25% (95% CI, 5%–51%) were diagnosed with pseudomembranous colitis, and the estimated length of ICU stay before CDI acquisition was 10.74 days (95% CI, 5%–51%). The overall hospital mortality among ICU patients with CDI was 32% (95% CI, 26%–39%), compared with 24% (95% CI, 14%–36%) among those without CDI presenting a statistically significant difference in mortality risk (P = .030). It is worth noting that the length of ICU and hospital stay among CDI patients was significantly longer, compared with non-CDI patients (standardized mean of difference [SMD] = 0.49, 95% CI, .39%–.6%, P = .00 and SMD = 1.15, 95% CI, .44%–1.91%, P = .003, respectively). It is noteworthy that the morbidity score at ICU admission (Acute Physiology and Chronic Health Evaluation II [APACHE II]) was not statistically different between the 2 groups (P = .911), implying that the differences in outcomes can be attributed to CDI. Conclusions.  The ICU setting is associated with higher prevalence of CDI. In this setting, CDI is associated with increased hospital mortality and prolonged ICU and overall hospital stay. These findings highlight the need for additional prevention and treatment studies in this setting.

scholarly journals Efficacy and Safety of Intranasal Ketamine for Acute Pain Management in the Emergency Setting: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (17) ◽  
pp. 3978
Author(s):  
Yee Sin Seak ◽  
Junainah Nor ◽  
Tuan Hairulnizam Tuan Kamauzaman ◽  
Ariff Arithra ◽  
Md Asiful Islam
Keyword(s):  
Systematic Review ◽  
Pain Management ◽  
Acute Pain ◽  
Meta Analysis ◽  
Emergency Setting ◽  
Efficacy And Safety ◽  
Acute Pain Management ◽  
Significant Difference ◽  
Mean Differences ◽  
Randomised Controlled

Due to overcrowding, personnel shortages, or problematic intravenous (IV) cannulation, acute pain management is often sub-optimal in emergency departments (EDs). The objective of this systematic review and meta-analysis was to evaluate the efficacy and safety of intranasal (IN) ketamine for adult acute pain in the emergency setting. We searched and identified studies up to 21 May 2021 via PubMed, Scopus, Web of Science, Cochrane Database, and Google Scholar. The random-effects model with 95% confidence intervals (CIs) was used to estimate mean differences (MDs) and odds ratios (ORs). The I2 statistic and Cochran’s Q test were used to determine heterogeneity. The protocol was registered in PROSPERO (CRD42020213391). Seven randomised controlled trials were included with a total of 1760 patients. There was no significant difference in pain scores comparing IN ketamine with IV analgesics or placebo at 5 (MD 0.94, p = 0.26), 15 (MD 0.15, p = 0.74), 25 (MD 0.24, p = 0.62), 30 (MD −0.05, p = 0.87), and 60 (MD −0.42, p = 0.53) minutes. There was also no significant difference in the need for rescue analgesics between IN ketamine and IV analgesics (OR 1.66, 95% CI: 0.57−4.86, p = 0.35, I2 = 70%). Only mild adverse effects were observed in patients who received IN ketamine. Our results suggest that IN ketamine is non-inferior to IV analgesics and may have a role in acute pain management among adults in the ED.

Regional differences in temporal incidence of Clostridium difficile infection: a systematic review and meta-analysis

2020 ◽  
Vol 48 (1) ◽  
pp. 89-94 ◽  
Author(s):  
Jeffery Ho ◽  
Sunny H. Wong ◽  
Vijaya C. Doddangoudar ◽  
Maureen V. Boost ◽  
Gary Tse ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Regional Differences ◽  
Meta Analysis ◽  
Temporal Incidence
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