The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

A RETROSPECTIVE REVIEW OF THE INCIDENCE RATIO OF CULTURE POSITIVE BAL SAMPLES TO CLOSTRIDIUM DIFFICILE POSITIVE PATIENTS IN AN URBAN TRAUMA MEDICAL CENTER

Roger W. Reichenbach1, Michael Malian1, Nik Pamukov1



Background: According to the CDC Clostridium Difficile (C. Diff.) incidence in Health Care Facilities is causing considerable concern and cause for alarm. First line antimicrobial agents are losing effectiveness in treating this infection. Recent Medicare guidelines eliminate reimbursement for nosocomial infections acquired after admission separate from the primary diagnosis. While broad spectrum antibiotics have become the mainstay of modern medicine, it is this current approach with antibiotics that has created this new virulent concern. In addition to C. Diff continued attention to evidence based practice to current problems such as Ventilator/Health Care Associated Pneumonia (VAP/HCAP). It is with great economic interest that clinicians need to be cognizant of the possible relationship i.e. precursor or symbiotic relationship of one infection (C. Diff) and other(s) such as VAP /HCAP. Once this is understood, newer efficient evidenced based treatment strategies can be utilized for best outcomes. Immune system augmentation via gut restoration of normal flora and yet to be understood cellular mediators are one possible strategy using possible agents as probiotics.

Methods: After seeking approval from the Institutional Review Board, A retrospective review of 1,582 patients on the trauma service (4/07-5/08) of a 1000 bed urban teaching medical center. Of the 1,582 patients admitted 24 were confirmed to have C. Diff by assay of toxin A or B. Of the 24 patients, 9 (37.5 %) had positive Bronchalveolar Cultures necessitating treatment. Coincidentally, 8 (33 %) had positive Urinary tract infections.

Results: Of the 1,582 patients admitted 24 were confirmed to have C. Diff by assay of toxin A or B. Of the 24 patients, 9 (37.5 %) had positive Bronchalveolar Cultures necessitating treatment. Coincidentally, 8 (33 %) had positive Urinary tract infections.

Conclusion: A possible treatment strategy is to boost immune response via IgA or gut immunomodulation. Probiotics are one approach to do this. Further double blind research is needed to ascertain the role of probiotics in C. Diff and co-existent antibiotic induced infections. Possible outcome data to include reduction in Ventilator days, ICU length of stay, positive C. Diff cultures, and a reduction in culture positive VAP/HCAP.