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This is a bit of the subject of biotech and a bit to clinical maybe be in the end it's all about patient outcome?

Without having any hard numbers to go on (our system doesn't even use computers yet so it is hard to track these things in my hospital) I would say the number one thing we did to decrease mortality was the use of high dose vanco PO or by nasogastric tube (and also by rectum when patients are very sick). Our patients are old and don't die anymore of c diff. We haven't had an ICU death in over 6 months since we started giving high dose vanco early and enterally. Data to be published when and if we ever have the time and money and and and... The VRE thing is theoretical. Haven't had that problem yet and we think the complication we don't have is less scary then the one we do have...


For any MDs with this clinical problem try high dose vanco (500 mg QID PO with flagly IV or PO) on your next c diff patient and start it before they go into septic shock! It's surprisingly effective. Our microbiology clinicians were sceptical at first (they are a very very conservative bunch and don't do well with new ideas) and actually tried blocking us from trying this. They originally favored colectomies... Vanco PO is a lot less morbide (and cheaper) then a colectomy! We lost about 20 patients before figuring out how to manage them. Like I said they don't or rarely die. The problem now is that literature coming out of the US by surgery seems to think the solution to all ills is a colectomy.
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