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Screening of Shiga-toxigenic Escherichia coli in Clinical Fecal Samples: A Review of Diagnostic Accuracy, Clinical Utility, Cost-Effectiveness and Guidelines [Internet]

The purpose of this report is to review the diagnostic accuracy of methods for the identification of Shiga toxigenic E.coli (STEC), the clinical utility of STEC testing, the cost-effectiveness of STEC screening, and the evidence-based guidelines regarding STEC screening.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: July 8, 2015
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Vaccines for preventing diarrhoea caused by enterotoxigenic Escherichia coli bacteria

Enterotoxigenic E. coli (ETEC) is a type of bacteria that can infect both children and adults, causing diarrhoea. In particular, it affects people in developing countries. However, it is also a major cause of 'travellers' diarrhoea' in people visiting or returning from regions where this infection is common. It is transmitted from person to person by eating or drinking unclean food or water. Typically it causes watery diarrhoea, with abdominal pains and vomiting, that can last for several days. Vaccines are being considered as a way to prevent diarrhoea caused by ETEC bacteria. ETEC bacteria share some similarities with the bacteria that cause cholera. In this review, we examined the effectiveness of either vaccines designed to prevent cholera or vaccines designed specifically to prevent ETEC infection for preventing ETEC diarrhoea. We compared these vaccines against the use of a control vaccine (either an inert vaccine or a vaccine normally given to prevent an unrelated infection), no intervention, an alternative ETEC vaccine, or a different dose or schedule of the same ETEC vaccine.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

A systematic review of vaccinations to reduce the shedding of Escherichia coli O157 in the faeces of domestic ruminants

The objective of this study was to conduct a systematic review and meta-analysis of the published literature to evaluate the efficacy of vaccines in reducing faecal shedding of Escherichia coli O157 in ruminants. A systematic search of eight databases and land-grant university research reports using an algorithm adapted from a previous systematic review of pre-harvest interventions against E. coli O157 was conducted to locate all reports of in vivo trials of E. coli O157 vaccines in ruminants published between 1990 and 2010. All located references were screened by two independent reviewers, and data were extracted from all relevant papers, with treatment effect measured in odds ratios. For trials with a faecal prevalence outcome that did not involve mixing of treated and untreated cattle in the same pen, efficacy was explored using random-effects meta-analysis. Funnel plots were used to evaluate publication bias, and random-effects meta-regression was performed to explore heterogeneity. The search located 20 relevant manuscripts which detailed 24 trials and 46 treatment comparisons; all but one trial involved cattle. There were 9 deliberate challenge trials (19 comparisons), and 15 natural exposure trials (27 comparisons). For Type III protein vaccines, there were 9 natural exposure trials detailing 17 comparisons, and meta-analysis of 8 comparisons revealed that vaccine treatment resulted in a statistically significant reduction in E. coli O157 faecal prevalence [odds ratio (OR)=0.38, 95% confidence interval (CI)=0.29, 0.51]. Siderophore receptor and porin protein (SRP) vaccines (three trials/four comparisons) also reduced faecal prevalence (OR=0.42, 95% CI=0.20, 0.61); however, none of the bacterin vaccine trials (n=3, six comparisons) resulted in a statistically significant reduction in prevalence. The results suggest that Type III protein and SRP vaccines significantly reduce faecal shedding in cattle; however, caution should be taken in interpreting the results because of the heterogeneity in the results.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Efficacy of rifaximin in prevention of travelers' diarrhea: a meta-analysis of randomized, double-blind, placebo-controlled trials

BACKGROUND: Rifaximin has been used successfully for the prevention of travelers' diarrhea (TD), the most general cause of disability among international travelers to developing tropical and semitropical regions.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Vaccines for the prevention of diarrhea due to cholera, shigella, ETEC and rotavirus

BACKGROUND: Diarrhea is a leading cause of mortality in children under 5 years along with its long-term impact on growth and cognitive development. Despite advances in the understanding of diarrheal disorders and management strategies, globally nearly 750,000 children die annually as a consequence of diarrhea.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

A systematic review of the clinical, public health and cost-effectiveness of rapid diagnostic tests for the detection and identification of bacterial intestinal pathogens in faeces and food

OBJECTIVES: To determine the diagnostic accuracy of tests for the rapid diagnosis of bacterial food poisoning in clinical and public health practice and to estimate the cost-effectiveness of these assays in a hypothetical population in order to inform policy on the use of these tests.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

Acute infectious diarrhea: Common germs and routes of infection

In Germany, infectious diarrhea is most commonly caused by the norovirus. Infants and young children often have rotavirus infections as well. Viral infections are usually quite intense but short. Bacterial infectious diarrhea is also widespread in adults.Infections with the highly contagious norovirus or rotavirus typically start with sudden and severe symptoms such as diarrhea or vomiting. These symptoms usually go away after a few days. Since 2013, the German Standing Committee on Vaccination (STIKO) has recommended that infants be vaccinated against the rotavirus.Bacterial infectious diarrhea is most often caused by eating contaminated or spoiled food. Like viruses, bacteria such as Campylobacter or Salmonella can also be transmitted through direct contact with infected people or by touching contaminated objects.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: May 4, 2016

Somatropin (Genotropin) for Subcutaneous Injection: The Treatment of Short Stature Associated with Turner Syndrome in Patients Whose Epiphyses are not Closed [Internet]

Turner syndrome (TS) is characterized by the absence of all or part of a normal second sex chromosome in females. Around 50% of patients with TS have sex chromosome abnormalities, while the remaining half have one sex chromosome. Mutations of chromosomes in patients with TS lead to a range of clinical features including, but not limited to, short stature. Adult height of untreated women with TS is approximately 20 cm shorter than that of adult women in the general population, with the average height being around 143 cm. Recombinant human growth hormone (rhGH), also called somatropin, is used to accelerate short-term growth in girls with TS.

Common Drug Review - Canadian Agency for Drugs and Technologies in Health.

Version: January 2014
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Neutropenic Sepsis: Prevention and Management of Neutropenic Sepsis in Cancer Patients

Guidelines are recommendations for the care of individuals in specific clinical conditions or circumstances - and these can include prevention and self-care through to primary and secondary care and on to more specialised services. NICE clinical guidelines are based on the best available evidence of clinical and cost effectiveness, and are produced to help healthcare professionals and patients make informed choices about appropriate healthcare. While guidelines assist the practice of healthcare professionals, they do not replace their knowledge and skills.

NICE Clinical Guidelines - National Institute for Health and Clinical Excellence (UK).

Version: September 2012
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Sepsis and 'superbugs': should we favour the transperineal over the transrectal approach for prostate biopsy?

OBJECTIVE: To determine the rate of hospital re-admission for sepsis after transperineal (TP) biopsy using both local data and worldwide literature, as there is growing interest in TP biopsy as an alternative to transrectal ultrasonography (TRUS)-guided biopsy for patients undergoing repeat prostate biopsy.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Screening, Isolation, and Decolonization Strategies for Vancomycin-Resistant Enterococci or Extended Spectrum Beta-Lactamase Producing Organisms: A Systematic Review of the Clinical Evidence and Health Services Impact [Internet]

Bacterial resistance to antibiotics is an increasing problem in Canada and worldwide. Vancomycin-resistant enterococci (VRE) are strains of Enterococcus faecium or Enterococcus faecalis that contain genes conferring resistance to vancomycin. Escherichia coli (E. coli), Klebsiella pneumonia (K. pneumonia), and other gram-negative bacteria may produce the enzymes known as extended spectrum beta-lactamases (ESBL). These have the ability to inactivate beta lactam antibiotics such as penicillin, ampicillin, and the cephalosporins.

Rapid Response Report: Systematic Review - Canadian Agency for Drugs and Technologies in Health.

Version: September 2012
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A meta-analysis of the benefit of probiotics in maintaining remission of human ulcerative colitis: evidence for prevention of disease relapse and maintenance of remission

This review concluded that probiotics were effective in maintaining remission in patients with ulcerative colitis and their effect in preventing relapse was comparable with mesalazine. Language, publication and reviewer bias were possible and trials of unknown quality may have been pooled inappropriately, so the authors' conclusions should be viewed with caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

What is the evidence for the use of probiotics in the treatment of inflammatory bowel disease?

The review appeared to conclude that most of the probiotics studied had beneficial effects in the treatment of inflammatory bowel disease, especially when taken as a dietary supplement with standard treatment, but that further research is needed. The review had several limitations which reduces the reliability of the conclusions, but the authors' call for further research appears appropriate.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Systematic review of the economic value of diarrheal vaccines

Diarrheal disease is a leading cause of child mortality in low-income settings and morbidity across a range of settings. A growing number of studies have addressed the economic value of new and emerging vaccines to reduce this threat. We conducted a systematic review to assess the economic value of diarrheal vaccines targeting a range of pathogens in different settings. The majority of studies focused on the economic value of rotavirus vaccines in different settings, with most of these concluding that vaccination would provide significant economic benefits across a range of vaccine prices. There is also evidence of the economic benefits of cholera vaccines in specific contexts. For other potential diarrheal vaccines data are limited and often hypothetical. Across all target pathogens and contexts, the evidence of economic value focuses the short-term health and economic gains. Additional information is needed on the broader social and long-term economic value of diarrhea vaccines.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

MALDI-TOF Mass Spectrometry for Pathogen Identification: A Review of Accuracy and Clinical Effectiveness [Internet]

This Rapid Response report reviews the accuracy and clinical impact of Matrix Assisted Laser Desorption Ionization Time of Flight (MALDI-TOF) mass spectrometry (MS) for the identification of microbial pathogens. This report was reviewed by experts in clinical microbiology and bacteriology and mycology.

Rapid Response Report: Peer-Reviewed Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: October 16, 2015
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Urinary Tract Infection in Children: Diagnosis, Treatment and Long-term Management

In the past 30–50 years, the natural history of urinary tract infection (UTI) in children has changed as a result of the introduction of antibiotics and improvements in health care. This change has contributed to uncertainty about the most appropriate and effective way to diagnose and treat UTI in children and whether or not investigations and follow-up are justified.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: August 2007
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Donor Breast Milk Banks: The Operation of Donor Milk Bank Services

Seventeen donor breast milk banks are currently in operation in the UK. These provide donor milk to babies, including pre-term babies and babies with growth restriction.

NICE Clinical Guidelines - National Institute for Health and Clinical Excellence (UK).

Version: February 2010
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Preventing cystitis

There is no sure-fire way to prevent cystitis. Medication for the prevention of cystitis needs to be taken for a long time and often has side effects. Other medicines are ineffective or haven't been studied enough. But it can be worth paying attention to certain things in everyday life. Although cystitis (a urinary tract infection, or UTI) isn't usually a big problem, the symptoms can be so unpleasant that they have a major impact on day-to-day life. Some women find their symptoms embarrassing too. People who have recurrent cystitis sometimes avoid activities such as swimming and may not feel like having sex. For these reasons, many women would like to try to prevent cystitis from arising in the first place.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: December 6, 2016

Cranberry Products or Topical Estrogen-Based Therapy for the Prevention of Urinary Tract Infections: A Review of Clinical Effectiveness and Guidelines [Internet]

The purpose of this report is to retrieve and review existing evidence of the clinical efficacy, safety and guidelines for the use of cranberry products and topical estrogen-based therapies for Urinary tract infection (UTI) prophylaxis.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: October 27, 2016
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Diarrhoea and Vomiting Caused by Gastroenteritis: Diagnosis, Assessment and Management in Children Younger than 5 Years

When young children suddenly experience the onset of diarrhoea, with or without vomiting, infective gastroenteritis is by far the most common explanation. A range of enteric viruses, bacteria and protozoal pathogens may be responsible. Viral infections account for most cases in the developed world. Gastroenteritis is very common, with many infants and young children experiencing more than one episode in a year.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: April 2009
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