What risk factors contribute to C difficile diarrhea?

Certain antibiotics and using 3 or more antibiotics at one time are associated with Clostridium difficile-associated diarrhea (CDAD) (strength of recommendation [SOR]: B, 1 heterogeneous systematic review and several good-quality cohort studies). Hospital risk factors include proximity to other patients with C difficile and longer length of stay (SOR: B, several good-quality cohort studies). Patient risk factors include advanced age and comorbid conditions (SOR: B, several good-quality cohort studies). Acid suppression medication is also a risk factor for CDAD (SOR: B, 1 heterogeneous systematic review and 2 good-quality cohort studies)

Herpes zoster

This issue of eMedRef provides information to clinicians on the pathophysiology, diagnosis, and therapeutics of herpes zoste

Cervicitis

This issue of eMedRef provides information to clinicians on the pathophysiology, diagnosis, and therapeutics of cervicitis

Associations of child food insecurity in Florida with social determinants of health and child population health outcomes

Background: Child food insecurity (CFI) in Florida is 25% higher than the national average, however, no studies currently exist which investigate the association between CFI and population health or social determinants of health in the State. The goal of this study was to identify those variables in order to inform future policy addressing CFI in the state of Florida. Methods: Data on CFI, child health, and social determinants of health were collected from the Florida Department of Health website for the years 2014-2018. Variables were selected based on previous studies on CFI conducted primarily in the United States. A correlation analysis was conducted to determine associations between the selected variables and CFI in Florida. Results: CFI had a moderate positive association with emergency department visits among children aged 0-5 in the years 2017 and 2018. All other child health outcomes examined in this study did not have significant associations with CFI. Teenage mothers represented the strongest positive association with CFI whereas breastfeeding represented the strongest negative association.  Conclusion: In Florida, CFI surprisingly had few correlations with population health outcomes that have known national associations. This indicates that the factors contributing to and resulting from CFI are different in Florida relative to those found nationally. Several social determinants of health were identified that could help identify individuals and communities at increased odds of having CFI

Global burden of Clostridium difficile infections::a systematic review and meta-analysis

Background: Clostridium difficile is a leading cause of morbidity and mortality in several countries. However, there are limited evidence characterizing its role as a global public health problem. We conducted a systematic review to provide a comprehensive overview of C. difficile infections (CDI) rates.Methods: Seven databases were searched (January 2016) to identify studies and surveillance reports published between 2005 and 2015 reporting CDI incidence rates. CDI incidence rates for health care facility-associated (HCF), hospital onset-health care facility-associated, medical or general intensive care unit (ICU), internal medicine (IM), long-term care facility (LTCF), and community-associated (CA) were extracted and standardized. Meta-analysis was conducted using a random effects model.Results: 229 publications, with data from 41 countries, were included. The overall rate of HCF-CDI was 2.24 (95% confidence interval CI = 1.66- 3.03) per 1000 admissions/y and 3.54 (95%CI = 3.19-3.92) per 10 000 patient- days/y. Estimated rates for CDI with onset in ICU or IM wards were 11.08 (95%CI = 7.19-17.08) and 10.80 (95%CI = 3.15-37.06) per 1000 admission/ y, respectively. Rates for CA-CDI were lower: 0.55 (95%CI = 0.13- 2.37) per 1000 admissions/y. CDI rates were generally higher in North America and among the elderly but similar rates were identified in other regions and age groups.Conclusions: Our review highlights the widespread burden of disease of C. difficile, evidence gaps, and the need for sustainable surveillance of CDI in the health care setting and the community.</p

Impact of gastrointestinal tract variability on oral drug absorption and pharmacokinetics : an UNGAP review

The absorption of oral drugs is frequently plagued by significant variability with potentially serious therapeutic consequences. The source of variability can be traced back to interindividual variability in physiology, differences in special populations (age- and disease-dependent), drug and formulation properties, or food-drug interactions. Clinical evidence for the impact of some of these factors on drug pharmacokinetic variability is mounting: e.g. gastric pH and emptying time, small intestinal fluid properties, differences in pediatrics and the elderly, and surgical changes in gastrointestinal anatomy. However, the link of colonic factors variability (transit time, fluid composition, microbiome), sex differences (male vs. female) and gut-related diseases (chronic constipation, anorexia and cachexia) to drug absorption variability has not been firmly established yet. At the same time, a way to decrease oral drug pharmacokinetic variability is provided by the pharmaceutical industry: clinical evidence suggests that formulation approaches employed during drug development can decrease the variability in oral exposure. This review outlines the main drivers of oral drug exposure variability and potential approaches to overcome them, while highlighting existing knowledge gaps and guiding future studies in this area