So If It’s Not C. Diff, What Is It?

This is disconcerting (boldface mine):

Fewer than one in six patients treated with powerful antibiotics for a Clostridium difficile (C. Diff) infection actually had lab-confirmed infections despite high costs and negative outcomes of unnecessary treatments, researchers reported here.

At a 240-bed hospital, over the course of 22 months, 1,971 patients were treated with vancomycin and/or metronidazole for a C. Diff infection, but only 292 of those patients had positive test results for C. Diff, Daniel Barone, PharmD, of Mercy Medical Center-North Iowa, in Mason City, and colleagues reported at the midyear meeting of the American Society of Health-System Pharmacists….

The researchers analyzed data from the 1,971 patients treated for C. Diff infections at the 240-bed hospital from February 2012 through November 2013. All of the patients had been in the hospital for at least 3 days and were treated with either vancomycin or metronidazole in IV or oral form.

This means that around 75 patients per month are getting treated with unnecessary antibiotics, including vancomycin, the last line of defense against MRSA. And this is a small hospital: Massachusetts General has over 1,500 beds; Boston’s Brigham and Women’s has almost 800 beds.

It also makes you wonder what is really wrong with these patients. If it’s not C. difficile, then what is it? Potentially, there’s an underlying problem which is going untreated.

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5 Responses to So If It’s Not C. Diff, What Is It?

  1. The right wingnuts will blame it on Obama.

    There is a problem that lab tests have a hard time detecting infection types. I was in the hospital 4 times with Cellulitis and lab tests couldn’t detect what kind of infection until the third admittance. Even then the doctors were not completely convinced.

  2. whizbangkey says:

    But once treated with antibiotics they may develop c. Dif and you then have something to treat.

  3. dr2chase says:

    I would wonder, what sort of symptoms did they have that caused doctors to think that they had C. diff, and did they go away after treatment?

  4. Paul Orwin says:

    How good is the test? they suck to culture (although cls labs have better equipment than I do), and I’m not sure serology is sensitive enough to find them in all the firmicutes in the normal gut/feces. But I really don’t know. Are there comparable gi diseases and data on diagnostic test efficacy?

  5. Morris says:

    It’s standard procedure for doctors to treat certain infections before waiting for lab confirmation. It’s not some sort of conspiracy. I was treated for C. diff once. The lab tests took a week to come back. And yes, I did have it. I don’t know if it just took that long to grow in culture, or if there was bureaucracy in the way too, possibly both. But I got a metronidazole prescription that same day.

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