GI

Cdiff detection by swab as good as by stool sample

In this small single center prospective cohort, patients with suspected Cdiff submitted a stool sample and a rectal swab for PCR testing. The rectal swab was found to have a sensitivity and specificity of 96% and 100% respectively. This may be a much more user-friendly way to collect diagnostic testing for patients with suspected Cdiff (abstract).

Risk factors for GI bleeding outside the ICU

This large single center cohort found several factors associated with the risk of non-ICU GI bleeding; researchers developed a scoring system to determine which patients were at highest risk of bleeding (and presumably would benefit from GI prophylaxis). The following factors were included (including their score): age >60 (2), male (2), acute renal failure, (2) liver disease (2), sepsis (2), VTE prophylaxis (2), coagulopathy (3), medical service (3). Those at highest risk (score 12+) had a GI bleed in 3.2% of those not on GI prophylaxis, and 1.1% of those on GI prophylaxis. This helps define those non-ICU hospitalized patients that would benefit from GI prophylaxis (abstract).

Restrict transfusions for UGI bleeding

This trial of almost 1,000 patients with acute upper GI bleeding randomized them to a restrictive (Hb<7) or liberal (Hb<9) transfusion strategy. Only 15% of the liberal, and 51% of the restrictive group did not receive a transfusion; 6 week survival was higher in the restrictive group (95% vs 91%), recurrent bleeding was lower (10% vs 16%),  and adverse events were lower (40% vs 48%). A restrictive transfusion strategy should be applied to patients with acute UGI bleed (abstract).

Can RBC transfusions worsen UGI bleeding?

This large retrospective database analysis of patients with non-variceal UGI bleed found, after adjusting for confounders, that those who received transfusions were significantly more likely to rebleed than those that did not receive transfusions (odds ratio 1.8, CI 1.2 to 2.8). As with other conditions, RBC transfusions should only be administered when absolutely necessary, but the exact threshold will need to be further delineated with randomized trials (abstract).

Cdiff 9th leading cause of GI death

This large database analysis found that Cdiff is now the 9th leading cause of GI death in the US, and that hospitalizations and mortality from Cdiff have more than doubled in the last decade (abstract).
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