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Distinguishing recurrent Clostridium difficile infection (CDI), defined as CDI caused by the same genotype, from reinfection with a different genotype, has important implications for surveillance and clinical trials investigating treatment effectiveness. We validated the proposed 8-week period for distinguishing “same genotype CDI” from “different genotype CDI,” and we aimed to identify clinical variables with distinctiveness to propose an improved definition.
From January 2004 to December 2013, a cohort of all inpatients with CDI at the University Hospital Basel, Switzerland, was established, and respective strains were collected. In patients with a second episode of CDI, both strains were compared using polymerase chain reaction (PCR) ribotyping. The standard definition of recurrence (within 8 weeks after initial diagnosis) was evaluated for its performance to predict CDI caused by the same genotype.
Among 750 patients with CDI, 130 (17.3%) were diagnosed with recurrence or reinfection. Strains from both episodes were available from 106 patients. Identical strains were identified in 36 patients with recurrence (36 of 47) and 27 patients with reinfection (27 of 59). Sensitivity, specificity, and negative and positive predictive values of the standard definition were 56%, 74%, 53%, and 76%, respectively. An extended period of 20 weeks resulted in the best match for both sensitivity and specificity (83% and 58%, respectively), while none of the clinical characteristics revealed independent distinctive power.
Our results challenge the utility of the 8-week cutoff for distinguishing recurrent CDI from reinfection. An extended period of 20 weeks may result in improved overall performance characteristics, but this finding requires external validation.
Seasonal distribution and abundance of anchovy eggs were analysed during three scientific cruises carried out from summer 2006 to summer 2007 in the Boka Kotorska Bay, and one cruise in July 2008 in the open waters of the south-eastern Adriatic Sea. Daily egg production method (DEPM) was applied for the first time for estimation of the anchovy spawning stock biomass in the south-eastern Adriatic Sea. The daily egg production was 13–581 eggs day−1 within the bay, and 42–110 eggs day−1 in the open waters. Anchovy egg abundance was highest in spring inside the Bay of Kotor (one of the innermost and eutrophic sub-bays of the Boka Kotorska Bay), which indicates that the conditions for anchovy spawning are very favourable in this part of the Adriatic Sea, even when temperatures are below the optimum. This study has shown that the Boka Kotorska Bay is an area of very intensive spawning of anchovy, and that small-size anchovies live and spawn in the bay, and after spawning migrate towards open waters. The length at which 50% of anchovy were mature (L50) was calculated as 9.28 for females and 9.02 for males. Spawning stock biomass was at a stable level during the period of investigation.
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