Infections à Clostridium difficile : aspects cliniques épidémiologiques et thérapeutiques

Clostridium difficile bacteremia: Report of two cases in French hospitals and comprehensive review of the literature

We report two cases of bacteremia due to Clostridium difficile from two French hospitals. The first patient with previously diagnosed rectal carcinoma underwent courses of chemotherapy, and antimicrobial treatment, and survived the C. difficile bacteremia. The second patient with colon perforation and newly diagnosed lung cancer underwent antimicrobial treatment in an ICU but died shortly after the episode of C. difficile bacteremia. A review of the literature allowed the identification of 137 cases of bacteremia between July 1962 and November 2016. Advanced age, gastro-intestinal disruption, severe underlying diseases and antimicrobial exposure were the major risk factors for C. difficile bacteremia. Antimicrobial therapy was primarily based on metronidazole and/or vancomycin. The crude mortality rate was 35% (21/60).

Risk factors for large colon volvulus in the UK

REASONS FOR PERFORMING STUDY

Risk factors for large colon volvulus (LCV) in the horse have not been previously reported. Knowledge of these risk factors may allow the introduction of measures that could be taken to minimise the incidence of LCV.

OBJECTIVES

To investigate risk factors for LCV in the horse.

METHODS

A prospective, multicentre, unmatched case-control study was conducted over a 24 month period in the UK. Data on 69 cases and 204 control horses, from 4 veterinary hospitals, were obtained via telephone questionnaires. Multivariable logistic regression was used to identify associations between horse and management-level variables and the likelihood of LCV.

RESULTS

Increasing height, multiple colic episodes in the previous 12 months and mares, with a greater odds ratio in mares that had previously foaled, were associated with increased risk of LCV. Receiving medication (excluding anthelmintic treatment) in the previous 7 days and quidding behaviour were also associated with increased risk. Management-level variables associated with greater risk of LCV were an increase in the hours of stabling in the previous 14 days, an increasing number of horses on the premises, and 3 or more people involved in the horse's care. Variables related to nutrition associated with increased risk of LCV were being fed hay, being fed sugar-beet, a change in pasture in the previous 28 days, and an alteration in the amount of forage fed in the last 7 days.

CONCLUSIONS

This study has identified factors that may assist in the recognition of horses with increased risk of LCV and factors that might be altered to minimise the incidence of LCV.

POTENTIAL RELEVANCE

Clinicians can use this information to identify horses at risk of LCV and to provide evidence-based advice to owners of these horses.