Two-year analysis of Clostridium difficile ribotypes associated with increased severity

Background

Certain Clostridium difficile ribotypes have been associated with complex disease phenotypes including recurrence and increased severity, especially the well-described hypervirulent RT027. This study aimed to determine the pattern of ribotypes causing infection and the association, if any, with severity.

Methods

All faecal samples submitted to a large diagnostic laboratory for C. difficile testing between 2011 and 2013 were subject to routine testing and culture. All C. difficile isolates were ribotyped, and associated clinical and demographic patient data were retrieved and linked to ribotyping data.

Results

In total, 86 distinct ribotypes were identified from 705 isolates of C. difficile. RT002 and RT015 were the most prevalent (22.5%, N=159). Only five isolates (0.7%) were hypervirulent RT027. Ninety of 450 (20%) patients with clinical information available died within 30 days of C. difficile isolation. RT220, one of the 10 most common ribotypes, was associated with elevated median C-reactive protein and significantly increased 30-day all-cause mortality compared with RT002 and RT015, and with all other ribotypes found in the study.

Conclusions

A wide range of C. difficile ribotypes were responsible for C. difficile infection presentations. Although C. difficile-associated mortality has reduced in recent years, expansion of lineages associated with increased severity could herald increases in future mortality. Enhanced surveillance for emerging lineages such as RT220 that are associated with more severe disease is required, with genomic approaches to dissect pathogenicity.

A Re-Examination of Personal and Group Estimates of the Kirton Adaption-Innovation Scores

90 participants from 8 training environments provided self-assessments and peer-assessments of Kirton Adaption-Innovation scores after receiving a briefing on the topic. Correlations gave confirmatory support for the convergent validity of the instrument; however, the results indicated a more complex pattern of correlations of self-assessments and peer-assessments with actual inventory scores than has been suggested in earlier studies. The nature of the decision-making process appears to be an overlooked factor associated with the effectiveness of peer-assessments.

The place of SGML and HTML in building electronic patient records

The authors are concerned that, although popular, SGML (Standard Generalized Markup Language) is only one approach to capturing, storing, viewing and exchanging healthcare information and does not provide a suitable paradigm for solving most of the problems associated with paper based patient record systems. Although a discussion of the relative merits of SGML, HTML (HyperText Markup Language) may be interesting, we feel such a discussion is avoiding the real issues associated with the most appropriate way to model, represent, and store electronic patient information in order to solve healthcare problems, and therefore the medical informatics community should firstly concern itself with these issues. The paper substantiates this viewpoint and concludes with some suggestions of how progress can be made.

Micromethod for Tocopherol Determination in Blood Serum

An improved microprocedure for the determination of tocopherol in blood serum is reported. Tocopherol is oxidized by ferric chloride and the pink complex of ferrous ions with 4,7-diphenyl-10,10-phenanthroline (bathophenanthroline) is determined spectrophotometrically. The test is more sensitive than colorimetric methods using 2,2',2''-tripyridine,2,2'-bipyridine (bipyridyl) or 2,4,6-tripyridyl-s-triazine. The use of phosphoric acid prevents the photochemical reduction of ferric chloride and also reduces interference of carotene to a minimum. The amount of carotene oxidized by ferric chloride in the first 5 min. is negligible in the presence of bathophenanthroline. As its further oxidation is stopped by phosphoric acid, the contribution of carotene to the ferrous-bathophenanonthroline complex is insignificant.