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3.2 CLINICAL MEDICINE
Background: Clostridium difficile is a leading cause of noscomial infection and is responsible for increased morbidity and mortality (Hookman & Barkin, 2009). There are limited data available on the nutritional status and dietetic management of these patients. Aims: 1. To carry out an observational study to assess the prevalence of the risk of malnutrition in patients with Clostridium difficile associated disease (CDAD) and compare it to a group of patients in the same hospital. 2. To investigate dietitians’ beliefs and recommendations of probiotics in CDAD and determine the probiotic products and strains being used in this patient group. To assess the current enteral feeding practices of dietitians in patients with CDAD. Methods: The Malnutrition Screening Tool (MUST) was used to assess the prevalence of risk of malnutrition in the patients with CDAD and a hospital comparison group. A questionnaire was sent to members of the Irish Nutrition and Dietetic Institute to gather information on dietitians’ opinions and use of probiotics and their enteral feeding practices in patients with CDAD. Results: There was no significant difference in the prevalence of malnutrition risk (MUST of 1 or more) between the CDAD group (75.5%) compared to the hospital comparison group (66.7%). The questionnaire response rate was 41% with 215 questionnaires undergoing analysis. One-third (34.5%) of dietitians considered probiotics to have a role in the prevention of CDAD yet only 11% used them in practice. Almost two-thirds (65.4%) believed that they have a role in the treatment of CDAD but only 40% regularly used them in practice. A yogurt drink containing Lactobacillus rhamnosus GG was mostly commonly available probiotic product for use by dietitians. When enterally feeding patients with CDAD, the majority of dietitians use a polymeric feed (79.6%). Conclusion: Both patient groups studied were at similar nutritional risk. There are mixed beliefs among Irish dietitians on the role of probiotics in CDAD. Probiotics are frequently recommended by dietitians in their clinical practice with little standardisation in practice. The probiotic strain that is most commonly being used in patients with CDAD does not have strong evidence to support its use.
Hickey, Y.: The Nutritional Status of Patients with Clostridium Difficile Associeated Disease and Dietetic Practices Concerning the Management of These Patients. Masters Thesis. Dublin Institute of Technology, 2012