Excerpt

Clostridium difficile infection (CDI) is a serious healthcare-associated infection and a growing health care problem, especially with the emergence of more virulent strains in the early 2000s. CDI is now the most common cause of nosocomial infectious diarrhea and is increasing in incidence and, in all likelihood, severity.

A comparative effectiveness review (CER) was prepared by the Minnesota Evidence-based Practice Center (EPC) on Comparative Effectiveness of Early Diagnosis, Prevention, and Treatment of Clostridium difficile Infection (December 2011). The purpose of the CER was to provide an overarching assessment of the evidence for comparing the accuracy of diagnostic tests and the effectiveness of prevention and treatment interventions on initial and recurrent CDI-related patient outcomes in adults.

Limited high-quality evidence was available to support the diagnostic, preventive, and treatment practices for CDI carried out by providers in hospital, long-term care, and outpatient settings. Inconsistency in definitions of diarrhea, severity, resolution of symptoms, recurrence, or cure contributed to the difficulty in drawing conclusions from the evidence. There were a number of important evidence gaps identified in the CER. The objective of this Future Research Needs project was to systematically prioritize evidence gaps on prevention and treatment of CDI, and to develop a list of research questions to address the prioritized gaps. Although different diagnostic methods for toxigenic Clostridium difficile were evaluated in the CER, diagnostic methods were not included in this project primarily because polymerase chain reaction testing is rapidly becoming the standard diagnostic test for the infection.

Contents

• Addendum
• Preface
• Acknowledgments
• Stakeholder Panel
• Executive Summary
• Introduction
  • Background
• Methods
  • Identification of Evidence Gaps
  • Project Scope
  • Literature Search Update
  • Criteria for Prioritization
  • Methods for Ranking Research Gaps
  • Engagement of Stakeholders, Researchers, Funders
  • Research Question Development and Study Design Considerations
• Results
  • Research Needs
• Discussion
• Conclusions
• References
• Abbreviations
• Appendix A Summary of Evidence from Comparative Effectiveness Review
• Appendix B Search Strategy for Ongoing Studies
• Appendix C Survey Tool Used to Rate Research Gaps
• Appendix D Survey Tool Used to Rate Research Questions
• Appendix E Survey Results of Evidence Gaps with List of Preliminary Research Questions
• Appendix F Survey Results of Research Questions with List of Ongoing Studies

Addendum added October 2012

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services¹, Contract No. 290-2007-10058-I, Prepared by: Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-based Practice Center, Chicago, IL

Suggested citation:

Noorani HZ, Soni N, Pitrak D, Belinson S, Aronson N. Future Research Needs for Prevention and Treatment of Clostridium difficile Infection. Future Research Needs Paper No. 17. (Prepared by the Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-based Practice Center under Contract No. 290-2007-10058-I.) AHRQ Publication No. 12-EHC100. Rockville, MD: Agency for Healthcare Research and Quality; May 2012. Addendum added October 2012. www.effectivehealthcare.ahrq.gov/reports/final.cfm.

This report is based on research conducted by the Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-based Practice Center (EPC) under contract to the Agency for healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10058-I). The findings and conclusions in this document are those of the author(s), who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help health care researchers and funders of research make well-informed decisions in designing and funding research and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of scientific judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical research and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances.

None of the investigators has any affiliations or financial involvement that conflicts with the material presented in this report.

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