scholarly journals Evaluation of Connecticut medical providers’ concordance with 2017 IDSA/SHEA Clostridioides difficile treatment guidelines in New Haven County, 2018–2019

2020 ◽  
pp. 1-8
Author(s):  
Casey Morgan Luc ◽  
Danyel Olson ◽  
David B. Banach ◽  
Paula Clogher ◽  
James Hadler
Keyword(s):  
Treatment Guidelines ◽  
Severe Disease ◽  
Recurrence Risk ◽  
Population Based ◽  
New Haven ◽  
Emerging Infections ◽  
Medical Providers ◽  
First Line ◽  
Clostridioides Difficile ◽  
Increased Risk

Abstract Objectives: To assess Connecticut medical providers’ concordance (2018–2019) with the 2017 Clostridioides difficile infection (CDI) treatment update by the Infectious Disease Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA). The effect of guideline concordance on CDI recurrence risk was also assessed. Design: Prospective, population-based study. Setting: New Haven County, Connecticut, from January 1, 2017, to December 31, 2019. Patients: CDI incident case (no positive tests in the prior 8 weeks), not limited by care setting. Methods: Using data from the Emerging Infections Program’s CDI surveillance, severity and concordance were defined. Presence of megacolon and/or ileus defined fulminant disease; absence defined nonsevere/severe disease. Using 2017 treatment as baseline, 2018–2019 concordance was defined as receiving the recommended first-line antibiotic (ie, vancomycin or fidaxomicin for adult patients, vancomycin or metronidazole for pediatric patients) for exactly 10 days. For all analyses, significance was P < .05. Results: Among 990 cases, concordance increased from 24.8% in 2018 to 37.0% in 2019. First-line antibiotic concordance increased from 61.2% in 2018 to 79.9% in 2019. Recurrence risk was significantly associated with patients aged ≥65 years and was highest for those aged 75–84 years, but this factor was not significantly associated with concordance. Conclusions: From 2018 through 2019, CDI treatment in New Haven County increasingly was concordant with the 2017 treatment update but remained low in 2019. Although concordance with treatment guidelines did not affect recurrence risk, close attention should be paid by medical providers to patients aged ≥65 years, specifically those aged 75–84 years because they are at an increased risk for recurrence.

scholarly journals 790. Evaluation of Connecticut Medical Providers Concordance with 2017 IDSA/SHEA Clostridioides difficile Treatment Guidelines in New Haven County, 2017-2019

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S439-S439
Author(s):  
Casey M Luc ◽  
Danyel M Olson ◽  
David Banach ◽  
James Hadler ◽  
Paula Clogher
Keyword(s):  
Treatment Guidelines ◽  
Recurrence Risk ◽  
P Value ◽  
New Haven ◽  
Emerging Infections ◽  
Medical Providers ◽  
First Line ◽  
Clostridioides Difficile ◽  
Increased Risk ◽  
Using Data

Abstract Background Treatment guidelines for Clostridioides difficile infection (CDI) were updated by the Infectious Disease Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA) in 2017, notably for disease severity and antibiotic recommendations. Our objectives were to assess Connecticut medical providers’ concordance (2017-2019) with the 2017 update. The effect of guideline concordance on the risk of CDI recurrence was also assessed. Methods Using data from the Connecticut Emerging Infections Program’s CDI surveillance in New Haven County, severity and concordance were defined. For severity, white blood cell count and presence of megacolon and/or ileus were used. Concordant treatment was defined as receiving the recommended first-line antibiotic (vancomycin for adult patients, vancomycin or metronidazole for pediatric patients) for exactly 10 days. In univariate & multivariate analyses, significance was determined by a p-value of &lt; 0.05. Results Of 1,216 cases, concordance increased from 10.0% in 2017 to 36.9% in 2019. Concordance with first-line antibiotic increased from 40.2% in 2017 to 80.8% in 2019. Concordance was highest for fulminant cases (62.2%). The recurrence rate was 11.2% and highest for non-severe cases and older cases but was not significantly associated with concordance. Concordance with selected treatment criteria by year, 2017-2019 Conclusion From 2017 through 2019, CDI treatment in New Haven County increasingly was concordant with the updated 2017 IDSA/SHEA guidelines, but still low overall in 2019. Although concordance with treatment did not affect recurrence risk, close attention should be paid by medical providers to non-severe cases and older cases as they are at an increased risk for recurrence. Disclosures All Authors: No reported disclosures

scholarly journals The association between gastro-oesophageal reflux disease and subsequent rheumatoid arthritis occurrence: a nested case–control study from Taiwan

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e016667 ◽  
Author(s):  
Herng-Ching Lin ◽  
Sudha Xirasagar ◽  
Cha-Ze Lee ◽  
Chung-Chien Huang ◽  
Chao-Hung Chen
Keyword(s):  
Rheumatoid Arthritis ◽  
Early Diagnosis ◽  
Reflux Disease ◽  
Treatment Guidelines ◽  
Population Based ◽  
Oesophageal Reflux ◽  
Study Patient ◽  
Oesophageal Reflux Disease ◽  
Increased Risk

ObjectiveGastro-oesophageal reflux disease (GORD) is a common comorbidity among patients with rheumatoid arthritis (RA). While GORD has been attributed to the antirheumatic medications, no studies of human cohorts have investigated a link between GORD and RA. This study investigates whether GORD is associated with a subsequent RA diagnosis over a 5-year follow-up using a population-based dataset.SettingTaiwanParticipantsWe used data from the Taiwan Longitudinal Health Insurance Database. The study group consisted of 13 645 patients with an ambulatory claim showing a GORD diagnosis. We used propensity score matching to select 13 645 comparison patients (one per study patient with GORD).InterventionWe tracked each patient’s claims over a 5-year period to identify those who subsequently received a diagnosis of RA. Cox proportional hazard (PH) regression modelling was used for analysis.ResultsOver 5-year follow-up, RA incidence rate per 1000 person-years was 2.81 among patients with GORD and 0.84 among the comparison group. Cox PH modelling showed that GORD was independently associated with a 2.84-fold increased risk of RA (95% CI 2.09 to 3.85) over 5-year follow-up, after adjusting for the number of ambulatory care visits within the year following the index date (to mitigate surveillance bias).ConclusionsWe observed that GORD might associate with subsequent RA occurrence. Because current treatment guidelines for RA emphasise early diagnosis and prompt treatment, the observed association between GORD and RA may help acquaint clinicians to patients with GORD with higher RA risk and facilitate early diagnosis and treatment.

scholarly journals 2435. The Impact of Treatment Strategy and Toxin Status on Outcomes of Patients with Clostridioides difficile Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S842-S842
Author(s):  
Daniel Friedman ◽  
Karen Zurek ◽  
Leyla Asadi ◽  
Mao-Cheng Lee ◽  
Holly Hoang
Keyword(s):  
Treatment Guidelines ◽  
Retrospective Chart Review ◽  
Toxin Production ◽  
Toxin Gene ◽  
Composite Outcome ◽  
Related Complication ◽  
Clostridioides Difficile ◽  
Increased Risk ◽  
Treatment Escalation ◽  
The Impact

Abstract Background Clostridioides difficile infection (CDI) is an important cause of morbidity and mortality and management continues to evolve. For laboratories that diagnose by detection of toxin gene, it is unclear whether reporting toxin production is additive to patient care. Furthermore, is there still a role for metronidazole (MNZ) given treatment guidelines now recommend vancomycin (VAN) as first-line therapy for non-severe cases? We analyzed cases of CDI in our hospital to assess outcomes of patients on MNZ vs. VAN and with or without toxin production. Methods A retrospective chart review of inpatients with CDI (based on detection of C. difficile toxin gene by PCR) was conducted between November 2017 and August 2018. Comparison of demographics and outcomes was performed in a) cases that were toxin-positive by enzyme immunoassay vs. negative and b) non-severe cases initially managed with MNZ vs. VAN. Results 76 patients were included (46 toxin-positive, 30 toxin-negative). Toxin-positive patients were older (mean age 77 vs. 62, p = 0.002) but had similar disease severity and initial treatment. A CDI recurrence occurred in 22% vs 0% in the toxin-positive cases (p = 0.006). Any CDI-related complication occurred in 23% of toxin-negative and 35% of toxin-positive cases (ns). After adjusting for toxin-status, age, and severity, the odds ratio of the composite outcome of any complication with toxin-positive CDI was not significant (OR 1.45 95% CI 0.45 -4.6, p = 0.52). There were 37 (49%) patients with non-severe CDI (27 MNZ, 10 VAN). Patients treated with VAN had higher stooling/day (6.3 vs 4.4, p = 0.04) and heart rate (p = 0.02). Initial MNZ use was associated with treatment escalation in 48% of cases compared with 10% in those treated with VAN alone (p = 0.03). CDI-associated mortality was higher in the VAN group (2/10 vs 0/27, p = 0.017). The rate of other complications was not significantly different. Conclusion Although no difference in the composite outcome of any CDI-related complication was detected between toxin positive vs negative patients, toxin-positivity may predict patients at risk for subsequent recurrence. Patients with non-severe CDI did not have increased risk of complications when managed with MNZ; however, they were more likely to require treatment escalation. Disclosures All authors: No reported disclosures.

Clostridioides difficile Infection in Children With Inflammatory Bowel Disease

2019 ◽  
Vol 26 (11) ◽  
pp. 1700-1706
Author(s):  
Abin Chandrakumar ◽  
Hussein Zohni ◽  
Wael El-Matary
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Cox Regression ◽  
Population Based ◽  
Incidence Rates ◽  
Categorical Variables ◽  
Fisher Exact Test ◽  
Clostridioides Difficile ◽  
Increased Risk ◽  
Inflammatory Bowel

Abstract Background The study’s objective was to investigate the incidence and risk factors associated with Clostridioides difficile (previously known as Clostridium) infection (CDI) in children with inflammatory bowel disease (IBD) in the province of Manitoba. Methods Our longitudinal population-based cohort was comprised of all children and young adults aged &lt;17 years diagnosed with IBD in the Canadian province of Manitoba between 2011 and 2019. The diagnosis of CDI was confirmed based on the Triage C. difficile immunoassay and polymerase chain reaction assay to detect the presence of toxigenic C. difficile. The Fisher exact test was used to examine the relationship between categorical variables. A Cox regression model was used to estimate the risk of CDI development in IBD patients. Results Among 261 children with IBD, 20 (7.7%) developed CDI with an incidence rate of 5.04 cases per 1000 person-years, and the median age at diagnosis (interquartile range) was 12.96 (9.33–15.81) years. The incidence rates of CDI among UC and CD patients were 4.16 cases per 1000 person-years and 5.88 cases per 1000 person-years, respectively (P = 0.46). Compared with children without CDI, those who had CDI were at increased risk of future exposure to systemic corticosteroids (adjusted hazard ratio [aHR], 4.38; 95% confidence interval [CI], 1.46–13.10) and anti–tumor necrosis factor (anti-TNF) biologics (aHR, 3.31; 95% CI, 1.11–9.90). The recurrence rate of CDI in our pediatric IBD population was 25%. Conclusions Our findings confirm that children with IBD are at high risk of developing CDI, which may predict future escalation of IBD therapy.

scholarly journals 1059. Staphylococcus aureus Bacteremia Treatment: Results From Pilot Surveillance in Four US States

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S316-S317
Author(s):  
Sarah Kabbani ◽  
Kelly Jackson ◽  
Lauren Epstein ◽  
Anita Gellert ◽  
Carmen Bernu ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Management Practices ◽  
Treatment Guidelines ◽  
Descriptive Analysis ◽  
Quality Measures ◽  
Population Based ◽  
Emerging Infections ◽  
Staphylococcus Aureus Bacteremia ◽  
Duration Of Hospitalization ◽  
Initial Culture

Abstract Background Staphylococcus aureus treatment guidelines are being revised to include proposed quality measures for evaluation of patients with S. aureus bacteremia (SAB) (e.g., infectious disease [ID] consultation, echocardiogram, and documenting clearance of bacteremia). We describe current management practices of SAB to identify opportunities for quality improvement. Methods We conducted a pilot assessment of SAB cases reported to CDC’s Emerging Infections Program active, laboratory- and population-based surveillance from 24 hospitals in four states during 1–2 months in 2017 or 2018. An SAB case was the isolation of S. aureus from a blood culture among adults (≥18 years) in the catchment area. We collected clinical and demographic information and performed a descriptive analysis of management of SAB cases. Results Among 109 SAB cases identified, 50 (46%) were methicillin-resistant S. aureus (MRSA). While hospitalized, 87 (80%) patients were evaluated by ID consultation, 90 (83%) underwent an echocardiogram (26 were transesophageal), and 92 (84%) had documented clearance of bacteremia. During the hospitalization, 15 (14%) died and 12 (11%) left against medical advice (AMA). Of those who survived and did not leave AMA, median duration of hospitalization after initial culture was 10.5 days (interquartile range 7–18). In total, 10 survivors (9% of cases) completed at least 2 weeks of antibiotics while hospitalized, and 65 (60% of cases) were discharged on antibiotic therapy. Among the 25 MRSA patients discharged on antibiotics, common treatments were vancomycin (64%), daptomycin (8%), ceftaroline (8%), and linezolid (4%). Among the 40 methicillin-susceptible SAB patients discharged on antibiotics, cefazolin (56%), ceftriaxone (13%), cefepime (5%), linezolid (5%), nafcillin (3%), and vancomycin (3%) were most common. The remainder of outpatient treatments included oral β-lactams, clindamycin, doxycycline, levofloxacin, and erythromycin. Conclusion Overall, the majority of patients with SAB underwent evaluation according to the proposed quality measures and received therapy with targeted anti-staphylococcal agents, although opportunities to optimize treatment remain. Hospitalized patients who leave AMA represent a particular challenge for effective SAB therapy. Disclosures All authors: No reported disclosures.

scholarly journals Are Patients Preferentially Receiving Oral Vancomycin for Clostridioides difficile Infection in 2018? A Population Perspective

2020 ◽  
Vol 41 (S1) ◽  
pp. s461-s462
Author(s):  
Dana Goodenough ◽  
Carolyn Mackey ◽  
Michael Woodworth ◽  
Max Adelman ◽  
Scott Fridkin
Keyword(s):  
Recurrent Infection ◽  
Population Based ◽  
Outpatient Setting ◽  
Definitive Treatment ◽  
Emerging Infections ◽  
Oral Vancomycin ◽  
Active Population ◽  
First Line Therapy ◽  
Clostridioides Difficile ◽  
Incident Cases

Background: Historically, metronidazole was first-line therapy for Clostridioides difficile infection (CDI). In February 2018, the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) updated clinical practice guidelines for CDI. The new guidelines recommend oral vancomycin or fidaxomicin for treatment of initial episode of CDI in adults. We examined the changes in treatment of CDI during 2018 across all types of healthcare settings in metropolitan Atlanta. Methods: Cases were identified through the Georgia Emerging Infections program (funded by the Centers for Disease Control and Prevention), which conducts active population-based surveillance in an 8-county area including Atlanta, Georgia (population, 4,126,399). An incident case was a resident of the catchment area with a positive C. difficile toxin test and no additional positive test in the previous 8 weeks. Recurrent CDI was defined as >1 incident CDI episode in 1 year. Clinical and treatment data were abstracted on a random 33% sample of adult (>17 years) cases. Definitive treatment categories were defined as the single antibiotic agent, metronidazole or vancomycin, used to complete a course. We examined the effect of time of infection, location of treatment, and number of CDI episodes on the use of metronidazole only. Results: We analyzed treatment information for 831 adult sampled cases. Overall, cases were treated at 29 hospitals (568 cases), 4 nursing homes (6 cases), and 101 outpatient providers (257 cases). The mean age was 60 (IQR, 34–86), and 111 (13.4%) had recurrent infection. Moreover, ∼28% of first-incident CDI episodes, 8% of second episodes, and 6% of third episodes were treated with metronidazole only. Compared to facility-based providers, outpatient providers were more likely to treat initial CDI episodes with metronidazole only (44% vs 21%; relative risk [RR], 2.1; 95% CI, 1.7–2.7). Treatment changed over time from 56% metronidazole only in January to 10% in December (Fig. 1). First-incident cases in the first quarter of 2018 were more likely to be treated with metronidazole only compared to those in the fourth quarter (RR, 2.76; 95% CI, 1.91–3.97). Conclusions: Preferential use of vancomycin for initial CDI episodes increased throughout 2018 but remained <100%. CDI episodes treated in the outpatient setting and nonrecurrent episodes were more likely to be treated with metronidazole only. Additional studies on persistent barriers to prescribing oral vancomycin, such as cost, are warranted.Funding: NoneDisclosures: Scott Fridkin reports that his spouse receives a consulting fee from the vaccine industry.

scholarly journals Smoking and the risk of COVID-19 in a large observational population study

2020 ◽  
Author(s):  
Ariel Israel ◽  
Elan Feldhamer ◽  
Amnon Lahad ◽  
Diane Levin-Zamir ◽  
Gil Lavie
Keyword(s):  
Severe Disease ◽  
Population Based ◽  
Population Based Study ◽  
Current Smoking ◽  
Increased Risk ◽  
Infection Mechanisms ◽  
Logistic Regressions ◽  
The Impact ◽  
Positive Results ◽  
Control Study

AbstractBACKGROUNDSmokers are generally more susceptible to infectious respiratory diseases and are at higher risk of developing severe complications from these infections. Conflicting reports exist regarding the impact of smoking on the risk of Coronavirus disease 2019 (COVID-19).METHODSWe carried out a population-based study among over 3,000,000 adult members of Clalit Health Services, the largest health provider in Israel. Since the beginning of the disease outbreak, and until May 16, 2020, over 145,000 adults underwent RT-PCR testing for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), and 3.3% had positive results. We performed a case-control study among patients who underwent SARS-CoV-2 testing, to assess the impact of smoking on infection incidence and severity. Individuals with positive tests were matched in a 1:5 ratio to individuals tested negative, of the same sex, age, and ethnicity/religion. Conditional logistic regressions were performed to evaluate odds ratios for current and previous smoking on the risk of testing positive. Multivariable logistic regressions were performed among patients infected with COVID-19 to estimate the association between smoking and fatal or severe disease requiring ventilation. Regressions were performed with and without adjustment for preexisting medical conditions.RESULTSCurrent smokers (9.8%) were significantly less prevalent among members tested positive compared to the general population (19.4%, P<0.001), and to matched members tested negative (18.2%, P<0.001). Current smoking was associated with significantly reduced odds ratio (OR) for testing positive OR=0.447 (95% confidence interval (CI) 0.400-0.501). Among patients tested positive, there was no evidence of significantly increased risk of developing severe or fatal disease.CONCLUSIONThe risk of infection by COVID-19 appears to be reduced by half among current smokers. This intriguing finding may reveal unique infection mechanisms present for COVID-19 which may be targeted to combat the disease and reduce its infection rate.

scholarly journals Multiplex PCR pathogen detection in acute gastroenteritis among hospitalized US children compared to healthy controls during 2011-2016 in the post rotavirus vaccine era

2021 ◽  
Author(s):  
Christopher J Harrison ◽  
Ferdaus Hassan ◽  
Brian Lee ◽  
Julie Boom ◽  
Leila C Sahni ◽  
...  
Keyword(s):  
Acute Gastroenteritis ◽  
Kansas City ◽  
Pathogen Detection ◽  
Signs And Symptoms ◽  
Population Based ◽  
Healthy Controls ◽  
Surveillance Network ◽  
Clostridioides Difficile ◽  
Increased Risk ◽  
Us Children

Abstract Background Despite vaccine-induced decreases in US rotavirus (RV) disease, acute gastroenteritis (AGE) remains relatively common. We evaluated AGE pathogen distribution in hospitalized US children in the post-RV-vaccine era. Methods From December 2011 to June 2016, the New Vaccine Surveillance Network (NVSN) conducted prospective, active, population-based surveillance in hospitalized children with AGE. We tested stools from two NVSN sites (Kansas City; Houston) with Luminex x-TAG Gastrointestinal Pathogen Panels (Luminex GPP) and analyzed selected signs and symptoms. Results For 660 pediatric AGE inpatients and 624 age-matched healthy controls (HC), overall organism detection was 51.2% and 20.6% respectively, p &lt;0.001. Among AGE subjects, GPP PCR detected &gt;1 virus in 39% and &gt;1 bacteria in 14% of specimens. Detection frequencies for AGE subjects vs. HC were: norovirus (NoV) 18.5% vs 6.6%, rotavirus (RV) 16.1% vs 9.8%, adenovirus 7.7% vs 1.4%, Shigella 4.8% vs 1.0%, Salmonella 3.1% vs 0.1%, Clostridioides difficile in ≥2-year olds 4.4% vs 2.4%. More co-detections occurred among AGE (37/660, 5.6%) than HC (14/624, 2.2%), p=0.0024. Per logistic regression analysis, ill contacts increased risk for NoV, RV and Shigella, p&lt;0.001. More vomiting episodes occurred with NoV and RV, and more diarrheal episodes with Shigella and Salmonella. Modified Vesikari scores were highest for Shigella and lowest for C. difficile. Conclusion NoV detection was most frequent, however RV remained important in hospitalized AGE in the post-RV-vaccine era. Continued active surveillance is important to document ongoing vaccine effects, pathogen emergence and baseline disease burden for new vaccines.

scholarly journals Systemic Inflammatory Mediators Are Effective Biomarkers for Predicting Adverse Outcomes in Clostridioides difficile Infection

mBio ◽  
2020 ◽  
Vol 11 (3) ◽  
Author(s):  
Michael G. Dieterle ◽  
Rosemary Putler ◽  
D. Alexander Perry ◽  
Anitha Menon ◽  
Lisa Abernathy-Close ◽  
...  
Keyword(s):  
Severe Disease ◽  
The United States ◽  
Human Infection ◽  
Serum Biomarkers ◽  
Adverse Outcomes ◽  
Gastrointestinal Infections ◽  
Content Type ◽  
Clostridioides Difficile ◽  
Increased Risk ◽  
Patients At Risk

ABSTRACT Clostridioides difficile infection (CDI) can result in severe disease and death, with no accurate models that allow for early prediction of adverse outcomes. To address this need, we sought to develop serum-based biomarker models to predict CDI outcomes. We prospectively collected sera ≤48 h after diagnosis of CDI in two cohorts. Biomarkers were measured with a custom multiplex bead array assay. Patients were classified using IDSA severity criteria and the development of disease-related complications (DRCs), which were defined as ICU admission, colectomy, and/or death attributed to CDI. Unadjusted and adjusted models were built using logistic and elastic net modeling. The best model for severity included procalcitonin (PCT) and hepatocyte growth factor (HGF) with an area (AUC) under the receiver operating characteristic (ROC) curve of 0.74 (95% confidence interval, 0.67 to 0.81). The best model for 30-day mortality included interleukin-8 (IL-8), PCT, CXCL-5, IP-10, and IL-2Rα with an AUC of 0.89 (0.84 to 0.95). The best model for DRCs included IL-8, procalcitonin, HGF, and IL-2Rα with an AUC of 0.84 (0.73 to 0.94). To validate our models, we employed experimental infection of mice with C. difficile. Antibiotic-treated mice were challenged with C. difficile and a similar panel of serum biomarkers was measured. Applying each model to the mouse cohort of severe and nonsevere CDI revealed AUCs of 0.59 (0.44 to 0.74), 0.96 (0.90 to 1.0), and 0.89 (0.81 to 0.97). In both human and murine CDI, models based on serum biomarkers predicted adverse CDI outcomes. Our results support the use of serum-based biomarker panels to inform Clostridioides difficile infection treatment. IMPORTANCE Each year in the United States, Clostridioides difficile causes nearly 500,000 gastrointestinal infections that range from mild diarrhea to severe colitis and death. The ability to identify patients at increased risk for severe disease or mortality at the time of diagnosis of C. difficile infection (CDI) would allow clinicians to effectively allocate disease modifying therapies. In this study, we developed models consisting of only a small number of serum biomarkers that are capable of predicting both 30-day all-cause mortality and adverse outcomes of patients at time of CDI diagnosis. We were able to validate these models through experimental mouse infection. This provides evidence that the biomarkers reflect the underlying pathophysiology and that our mouse model of CDI reflects the pathogenesis of human infection. Predictive models can not only assist clinicians in identifying patients at risk for severe CDI but also be utilized for targeted enrollment in clinical trials aimed at reduction of adverse outcomes from severe CDI.

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