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Biomedical subjects

Edward C Oldfield

Publications and source records attributed to Edward C Oldfield.

At least 19 recordsLinked to original sources
PubMed2006

Clostridium difficile-associated diarrhea: resurgence with a vengeance.

There has been a significant increase in the incidence and severity of Clostridium difficile-associated diarrhea (CDAD) in the past several years, including outbreaks in multiple states and provinces in the United States and Canada, as well as in the United Kingdom. A new, highly virulent strain of C. difficile has appeared that is less responsive to standard therapy and associated with a high rate of recurrence. Along with nosocomially acquired infections there has been a rise in the number of community-acquired cases of CDAD, even among those without prior antibiotic exposure. Many factors have contributed to this epidemic, including the development of resistance to the widely used fluoroquinolones class of antibiotics. Because this new strain is less responsive to standard therapy, particularly metronidazole, a number of new antibiotics and other therapies are actively being investigated for use in both primary and recurrent CDAD. A multifaceted approach to managing CDAD is called for, including active surveillance, antibiotic stewardship, and meticulous attention to contact precautions, including gloves, gowns, and hand washing.

Anti-Infective Agents↗
PubMed2005

Antibiotic prophylaxis in severe acute pancreatitis: the never-ending controversy.

Infections are the most common late cause of morbidity and mortality in severe acute pancreatitis. Between 1993 and 2004, a number of prospective controlled trials, meta-analyses, and guidelines all concluded that antibiotics were indicated for the prophylaxis of infections in severe acute pancreatitis. However, in 2004, the first prospective, double-blind, placebo-controlled trial was published showing no effect of prophylactic antibiotics, thus rekindling the controversy surrounding this subject. For those physicians who choose to use prophylactic antibiotics, their use should be limited to patients with pancreatic necrosis, and the choice of antibiotic should be guided by the drug's proven ability to penetrate into the pancreas. Evidence supports imipenem, meropenem, or cefepime for this indication. One third of patients will develop infection of pancreatic necrosis despite the use of prophylactic antibiotics. Vigilance must be maintained for evidence of recurrence of markers of inflammation or persistence beyond the first week, which would suggest the need for fine-needle aspiration and culture to detect infection. Physicians who choose not to use prophylactic antibiotics for pancreatic necrosis should be aware that they will need to initiate antibiotics in 54% to 77% of patients for either infection of pancreatic necrosis or extrapancreatic infections.

Acute Disease↗
PubMed2004

Clostridium difficile-associated diarrhea: risk factors, diagnostic methods, and treatment.

Clostridium difficile-associated diarrhea (CDAD) has become the most common cause of infectious diarrhea acquired in the hospital, with an estimated 3 million annual cases and an annual cost of $1 billion. Risk factors for CDAD include antibiotic use (especially ampicillin, clindamycin, and cephalosporins), advanced age, and gastrointestinal surgery. Specific diagnosis of CDAD is made with an enzyme immunoassay to detect toxins A and B. Metronidazole remains the initial treatment of choice, with a 95% success rate. Vancomycin is reserved for failures. Despite the high initial success rates, recurrence of CDAD remains a significant problem in 20% to 30% of cases, with increased cost and substantial morbidity. Efforts to prevent CDAD will need to be strengthened, including education and better compliance with isolation, use of gloves, and hand washing.

Anti-Bacterial Agents↗