GASTROENTEROLOGY ARTICLE OF THE WEEK
April 10, 2008
Monaghan T, Boswell T, Mahida YR. Recent advances in Clostridium difficile-associated disease. Gut; published online February 5, 2008 ahead of print publication.
1. Predisposing factors for C. difficile infection include:
a. age over 65 years
b. immunosuppression
c. disruption of the colonic flora
d. increased use of acid suppressing medications
e. recent increased used of probiotics
2. Metronidazole use for C. difficile colitis
a. Has been found to be equivalent to vancomycin in the vast majority of studies
b. Failure to respond to metronidazole is usually due to metronidazole-resistant strains of C. difficile
c. Metronidazole is only secreted into the colonic lumen in the presence of colonic inflammation
d. Studies have shown a shorter duration of symptoms with vancomycin therapy compared to metronidazole
3. Treatment of recurrent C. difficile
a. Randomized trials suggest increased efficacy with S. boulardii +vancomycin treatment.
b. The efficacy of pulsed or tapered vancomycin for recurrent C. difficile has been shown in randomized controlled trials
c. The use of prebiotics together with antimicrobial therapy may reduce the rate of C. difficile recurrence
d. Infusion of gamma globulin preparations should be considered in patients with recurrent C. difficile infection
4. The frequency of recurrent C. difficile colitis is:
a. 1%-5%
b. 40%-50%
c. 15%-30%
d. 5%-10%
True or False
5. Stopping antibiotic therapy without initiating antimicrobial therapy for C. difficile may be an effective strategy in patients with mild C. difficile infection.
6. Nitazoxanide has been found to be as effective as metronidazole for the treatment of C. difficile infection and is effective in most patients who failed metronidazole
7. NAP1/027 (or type BI) strain of C. difficile produces more toxin A and B than other strains and has been found more frequently in non-community acquired infections
8. Elevated levels of c-reactive protein and low serum albumin levels are more suggestive of IBD as the cause of diarrhea rather than C. difficile colitis
9. Rifaximin may be a potentially useful agent in the treatment of C. difficile
10. Patients who are immunocompromised and have severe acute C. difficile infection appear to benefit more from surgery than immunocompetent individuals.
11. Right sided hemorrhagic colitis is the typical presentation of Klebsiella oxytoca infection
12. Fluoroquinolones are a major risk factor for infection with the hypervirulent strain NAP1/027.
13. The prophylactic use of certain probiotics have been shown to decrease the incidence of C. difficile colitis in patients receiving antibiotics.