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The appendix may protect against Clostridium difficile recurrence

Im, Gene Y; Modayil, Rani J; Lin, Cheng T; Geier, Steven J; Katz, Douglas S; Feuerman, Martin; Grendell, James H
BACKGROUND & AIMS/OBJECTIVE:Several risk factors have been identified for the development of recurrent Clostridium difficile infection (CDI) that alter host immunity and disrupt colonic flora. Although the function of the appendix has been debated, its active, gut-associated lymphoid tissue and biofilm production indicate potential roles in recovery from initial CDI and protection against recurrent CDI. We investigated whether the presence or absence of an appendix is associated with CDI recurrence. METHODS:We reviewed the medical records of adult inpatients with CDI who were admitted to a tertiary-care teaching hospital from 2005 to 2007 to identify those with and without an appendix. The primary dependent variable for statistical analysis was CDI recurrence. RESULTS:In a multivariate analysis of 11 clinical variables, the presence of an appendix was associated inversely with CDI recurrence (P < .0001; adjusted relative risk, .398). Age older than 60 years also was associated with CDI recurrence (P = .0280; adjusted relative risk, 2.44). CONCLUSIONS:The presence of an appendix has a significant and independent, inverse association with CDI recurrence, but this finding requires validation in a prospective study. Assessing the presence or absence of an appendix might be useful in predicting CDI recurrence.
PMID: 21699818
ISSN: 1542-7714
CID: 3002622

Nucleic acid testing (NAT) of organ donors: is the 'best' test the right test? A consensus conference report

Humar, A; Morris, M; Blumberg, E; Freeman, R; Preiksaitis, J; Kiberd, B; Schweitzer, E; Ganz, S; Caliendo, A; Orlowski, J P; Wilson, B; Kotton, C; Michaels, M; Kleinman, S; Geier, S; Murphy, B; Green, M; Levi, M; Knoll, G; Segev, Dorry L; Brubaker, S; Hasz, R; Lebovitz, D J; Mulligan, D; O'Connor, K; Pruett, T; Mozes, M; Lee, I; Delmonico, F; Fischer, S
Nucleic acid testing (NAT) for HIV, HBV and HCV shortens the time between infection and detection by available testing. A group of experts was selected to develop recommendations for the use of NAT in the HIV/HBV/HCV screening of potential organ donors. The rapid turnaround times needed for donor testing and the risk of death while awaiting transplantation make organ donor screening different from screening blood-or tissue donors. In donors with no identified risk factors, there is insufficient evidence to recommend routine NAT, as the benefits of NAT may not outweigh the disadvantages of NAT especially when false-positive results can lead to loss of donor organs. For donors with identified behavioral risk factors, NAT should be considered to reduce the risk of transmission and increase organ utilization. Informed consent balancing the risks of donor-derived infection against the risk of remaining on the waiting list should be obtained at the time of candidate listing and again at the time of organ offer. In conclusion, there is insufficient evidence to recommend universal prospective screening of organ donors for HIV, HCV and HBV using current NAT platforms. Further study of viral screening modalities may reduce disease transmission risk without excessive donor loss.
PMID: 20121734
ISSN: 1600-6143
CID: 5129972