A Review of Experimental and Off-Label Therapies for Clostridium difficile Infection

<p><strong>Article full text</strong></p> <p><br> The full text of this article can be found <a href="https://link.springer.com/article/10.1007/s40121-016-0140-z"><b>here</b>.</a><br> <br> <strong>Provide enhanced content for this article</strong><br> If you are an author of this publication and would like to provide additional enhanced content for your article then please contact <u>[email protected]</u>.<br> <br> The journal offers a range of additional features designed to increase visibility and readership. All features will be thoroughly peer reviewed to ensure the content is of the highest scientific standard and all features are marked as ‘peer reviewed’ to ensure readers are aware that the content has been reviewed to the same level as the articles they are being presented alongside. Moreover, all sponsorship and disclosure information is included to provide complete transparency and adherence to good publication practices. This ensures that however the content is reached the reader has a full understanding of its origin. No fees are charged for hosting additional open access content.<br> <br> Other enhanced features include, but are not limited to:<br> • Slide decks<br> • Videos and animations<br> • Audio abstracts<br> • Audio slides</p> <p> </p

Time to blood culture positivity as a predictor of clinical outcomes and severity in adults with bacteremic pneumococcal pneumonia

<div><p>Objectives</p><p>We aimed to investigate the association between the time to positivity of blood culture (TTP) with clinical outcome and severity of pneumococcal bacteremic pneumonia.</p><p>Methods</p><p>Prospective observational study carried out in 278 hospitalized adult CAP patients with positive blood culture for <i>Streptococcus pneumonia</i> (2003–2015).</p><p>Results</p><p>A total of 278 cases of bacteremic pneumococcal pneumonia were analyzed, median age 62 (46; 79) years. Fifty-one percent of the cases had PSI IV-V. Twenty-one (8%) died within 30-days after admission. The analysis of the TTP showed that the first quartile of the TTP (9.2h) was the best cut-off for differentiating 2 groups of patients at risk, early (TTP <9.2 h) and late (TTP ≥9.2 h) detection groups (AUC 0.66 [95% CI 0.53 to 0.79]). Early TTP was associated with a statistically significant risk of invasive mechanical ventilation (18% vs. 6%, p = 0.007), longer length of hospital stay (12 days vs. 8 days, p<0.001), higher in-hospital mortality (15% vs. 4%, p = 0.010), and 30-day mortality (15% vs. 5%, p = 0.018). After adjustment for potential confounders, regression analyses revealed early TTP as independently associated with high risk of invasive mechanical ventilation (OR 4.60, 95% CI 1.63 to 13.03), longer length of hospital stay (β 5.20, 95% CI 1.81 to 8.52), higher in-hospital mortality (OR 5.35, 95% CI 1.55 to 18.53), and a trend to higher 30-day mortality (OR 2.47, 95% CI 0.85 to 7.21) to be a contributing factor.</p><p>Conclusion</p><p>Our results demonstrate that TTP is an easy to obtain surrogate marker of the severity of pneumococcal pneumonia and a good predictor of its outcome.</p></div

Receiver operating characteristic curve for PSI and modified PSI to predict in-hospital mortality.

<p>Receiver operating characteristic curve for PSI and modified PSI to predict in-hospital mortality.</p

Significant simple and multiple linear regression analyses to predict length of hospital stay.

<p>Significant simple and multiple linear regression analyses to predict length of hospital stay.</p

Receiver operating characteristic curve for CURB-65 and modified CURB-65 to predict in-hospital mortality.

<p>Receiver operating characteristic curve for CURB-65 and modified CURB-65 to predict in-hospital mortality.</p

Flow diagram of the selected population.

<p>Flow diagram of the selected population.</p

Time to positivity of <i>S</i>. <i>Pneumoniae</i> in blood culture.

<p>Time to positivity of <i>S</i>. <i>Pneumoniae</i> in blood culture.</p

Receiver operating characteristic curve for time to positivity of <i>S</i>. <i>pneumoniae</i> to predict in-hospital mortality.

<p>Receiver operating characteristic curve for time to positivity of <i>S</i>. <i>pneumoniae</i> to predict in-hospital mortality.</p

Multivariate multinomial logistic regression analyses to predict non-invasive or invasive mechanical ventilation relative to non-ventilated.

<p>Multivariate multinomial logistic regression analyses to predict non-invasive or invasive mechanical ventilation relative to non-ventilated.</p

Clinical outcomes.

<p>Clinical outcomes.</p