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"Time to Reanimate Il-1ra for Sepsis" by Steven P. LaRosa, M.D.

My introduction to the world of clinical trials in sepsis occurred in the 1990’s while I was an Internal Medicine Resident in the MICU at the Cleveland Clinic. My attending physician and ICU director, Charles J. Fisher, Jr, was the lead investigator for the Phase III trial of Interleukin-1 receptor antagonist (IL-1 ra) in patients with sepsis. The basis of the strategy related to the discovery by Charles Dinarello, M.D. of IL-1 and the role it played in the pathophysiology of febrile vasodilatory shock. During this rotation I had the opportunity to enroll a patient of mine into this trial. He was a previously healthy 28 year old male who perforated his bowel as an initial presentation of inflammatory bowel disease. At the time of enrollment the patient was maxed out on vasopressors for septic shock, in ARDS, DIC and acute renal failure. Within 24 hours of beginning the study drug infusion the patient had a miraculous improvement and ultimately survived. When the study blind was broke…
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C. diff Prevention "Tour de Force"

In the current issue of Clinical Infectious Disease Daniel Caroff and colleagues published an elegant article on the epidemiology and prevention of Clostridium difficile colitis. Many of the points that they make need to be emphasized in terms of how we operationalize C diff prevention efforts.
The most important points made in the paper are the following:
1) 10% of patients admitted to the hospital have asymptomatic C. diff colonization. This percentage is even higher in the following groups of patients:
a. Patients with recent hospitalizations b. Patients who have received recent antibiotics c. Patients who have recently had C. diff
2) Up to 30% of hospital -acquired C diff is likely acquired from those who are asymptomatically colonized and shedding C diff.
Based upon these 2 fundamental observations from the literature shouldn't we consider re-tooling our preventative efforts in the following ways?

1) Screening all admissions for asymptomatic C diff colonization or at least t…