Administering prophylactic antibiotics before surgery in order to prevent surgical site infections might actually increase a patient's risk of acquiring Clostridium difficile, say Canadian researchers.

In a study appearing in the June 15 issue of the journal Clinical Infectious Diseases, researchers who reviewed 8,373 surgical cases occurring between August 1999 and May 2005 reported a 21-fold increase in the likelihood of C. diff infection when perioperative antibacterial therapy was the sole antibiotic treatment.

The study's authors say antimicrobial therapy modifies the intestine's normal flora, creating an environment in which C. diff can thrive. They note the emergence of a hypervirulent strain of C.diff in 2000, which increased the number and severity of associated infections and amplified concern over this potentially deadly bacterium.

Due to the growing severity of C. diff infections - the study revealed that five of 40 patients who developed the infection died or suffered septic shock - the researchers suggest surgical cases be evaluated individually and question the risk-reward ratio of antibiotic therapies aimed at preventing infrequent or benign infections.

Additionally, says Louis Valiquette, MD, MSc, the study's lead author, shortening the duration of antibiotic prophylaxis will minimize the risk of C. diff infection while also decreasing medication costs, reducing microbial-related side effects and slowing bacterial resistance.

Daniel Cook

Cola may be helpful as a stomach prep before gastric endoscopy, but don't depend on it for rehydrating a child, says a pair of studies released last month.

In a study presented at Digestive Disease Week, cola was found to help dissolve food residue, bile reflux and solid pythobezoars, which can cause complications among endoscopy patients who have had bariatric surgery or a gastrectomy.

Researchers at the University College of Medicine in Seoul, South Korea, studied 70 endoscopy patients, 33 of whom drank 21 ounces (700 ml) of Coca-Cola the night before their procedures and 37 of whom had no prep. The next day, 10 percent of the patients in the no-prep group had enough residue in their stomachs to prevent complete visualization and in some cases to lead to procedure cancellations. For diabetic patients, the researchers suggested substituting Diet Coke. While the researchers were loyal to Coca-Cola, study author Jong-Jae Park, MD, noted that Pepsi-Cola should work just as well.

The secret, says Anaya Das, MD, of the Mayo Clinic in Scottsdale, Ariz., might be a lot of air. The cola's bubbles, not its ingredients, break up the pythobezoars, he says.

In other soft drink news, British researchers have found no evidence to support serving a child who's suffering vomiting or diarrhea a flat soft drink as an alternative to an oral rehydration solution. In their study, published in the May issue of the Archives of Disease in Childhood, the authors point to scientific analyses of carbonated drinks that show they fall far short of the World Health Organization's recommendations for sodium, potassium and water content in oral rehydration solutions. Cola has more than five times the recommended amount of sugar, but only 4 percent of the sodium and 1 percent of the potassium, they say.

Kent Steinriede

Mayo Clinic researchers have developed a high-resolution confocal endomicroscopy probe system that they say can determine the cancerous potential of polyps without removal and examination by a pathologist, a technology that may revolutionize the future of colonoscopy.

The probe system was 89 percent successful in determining whether polyps were precancerous or benign and 98 percent accurate in identifying benign polyps, eliminating the need for their removal and biopsy, according to recently released study results.

"Today, half of all polyps surgically removed during colonoscopy procedures are benign, and so this virtual biopsy will save time and expense, and reduce complications that can occur," says Michael Wallace, MD, MPH, professor of medicine at the Mayo Clinic and the study's senior author.

The imaging device is 1/16th of an inch in diameter and affixes to many current endoscope models. During colonoscopy the probe's fluorescent contrast illuminates suspicious polyps, magnifying the area by 1,000 times for a close examination of the lesion. So close, in fact, that a single red blood cell can be seen as it moves through a blood vessel, says the Mayo Clinic. Physicians are able to look for changes in cell color and size, examine the nuclei within cells and determine whether cells are fused or crowned with tissue.

"This (technology) will shift our role from one of going in and getting tissue for a pathologist to examine to one in which we can do the pathology ourselves," says Dr. Wallace. "This is instantaneous, real-time pathology."

Daniel Cook