Uncommon But Feasible S6 Kinase Procedures
?difficile [5], but also on those who have inflammatory bowel disease (IBD) concurrent with CDI [28], those who are seropositive for human immunodeficiency virus (HIV) infection [29], and those who undergo organ transplantation, particularly those with hypogammaglobulinaemia [30]. Patients with IBD are particularly susceptible to infection with C.?difficile, the presence of which may be masked by the fact that Lapatinib clinical trial diarrhoea is a common symptom of both Crohn's disease and ulcerative colitis. The outcome in patients with IBD can be severely compromised by CDI. A retrospective cohort study of almost 250?000 patients admitted to hospitals in England for IBD over a 6-year period showed that, among the 2402 patients who had IBD and concurrent CDI, death rates at 1?year were higher (33.1 vs. 6.7%, respectively) and inpatient stays longer (26 vs. 5?days, respectively) than for patients with IBD alone, and IBD patients with CDI were also twice as likely to undergo bowel surgery, including emergency colectomy [28]. Other groups of patients with compromised immune systems include HIV-seropositive patients and transplant recipients [29, 30]. A recent systematic review of CDI in HIV-seropositive patients and transplant recipients suggests that acquisition of CDI is associated with a poorer prognosis in these patients than in immunocompetent individuals [29]. CDI, which caused diarrhoea in 43% of hospitalized HIV patients, and has been identified as the most common Selleck LY294002 bacterial cause of HIV-related diarrhoea in other studies S6 Kinase [31] and in up to 31% of transplant recipients, is itself debilitating. It exacerbates the state of immunosuppression by compromising nutrition and other factors that influence immune function. By prolonging hospitalization and the need for intravenous rehydration, CDI also increases the risk of hospital-acquired infection, including re-infection with C.?difficile. This, in turn, will drive morbidity and mortality, particularly in the more severe cases, as highlighted in a recent review by Collini et?al. [29]. Infection with toxigenic strains of C.?difficile is a potentially life-threatening condition, especially among the small but increasing number of patients who develop fulminant colitis [32, 33]; nonetheless, CDI can still cause death in patients with less severe disease [34]. Data from the pan-European survey showed that the overall mortality rate was 22%, with CDI being directly responsible for c.?2% of all deaths and a contributor to death in a further 7% of cases [13]. These rates are much lower than those reported for the UK, where CDI-attributable mortality rates have exceeded 20% for several years (http://www.ons.gov.uk/ons/rel/subnational-health2/deaths-involving-clostridium-difficile/2009/deaths-involving-mrsa�Cengland-and-wales�C2009.pdf). Although CDI-attributable mortality rates have historically been
