IgG serum antibody was measured by ELISA in patients with Crohn's disease (15), ulcerative colitis (15), and in normal controls (15) to 12 strains ofSaccharomyces cerevisiae (baker's and brewer's yeast) and to the two major serotypes of the commensal yeast Candida albicans. Antibody to 11 of the 12 strains of S cerevisiae was raised in patients with Crohn's disease but not in patients with ulcerative colitis when compared with controls (p<0001). The pattern of antibody response to these 11 strains was variable, however, suggesting the likelihood of antigenic heterogeneity within the species. Antibody to C albicans was not significantly different in patient and control groups. The specificity of this unusual antibody response in Crohn's disease for S cerevisiae suggests that it is not simply the result of a generalised increase in intestinal permeability. Furthermore, because brewing and baking strains detected the response, the relevant antigen(s) are presumably common in the diet. Hypersensitivity to dietary antigens may be involved in the pathogenesis of Crohn's disease, and the role of S cerevisiae requires further investigation.
The effect of dietary yeast on the activity of stable Crohn's disease was assessed in 19 patients. During the 1st month patients continued their usual diet (base-line period), but during the next 2 months dietary yeast was excluded except that during 1 month patients took baker's yeast capsules while for the other month they took placebo capsules. The patients' mean Pettit Crohn's disease activity index (CDAI) while taking baker's yeast (mean, 107.9; SE, 6.1) was significantly greater than during yeast exclusion (mean, 102.1; SE, 5.7; p less than 0.05). The mean of each patient's maximum CDAI during yeast exclusion (mean, 107.1; SE, 5.7) was significantly lower than those during the base-line (mean, 115.2; SE, 6.1; p less than 0.05) and baker's yeast inclusion periods (mean, 113.9; SE, 6.7; p less than 0.05). Patients with elevated yeast antibodies tended to develop a higher CDAI while receiving baker's yeast (13 of 15). These results suggest that dietary yeast may affect the activity of Crohn's disease.
Since 1993, the infection consultation service for bacteraemia has seen 310 patients in the Medical and Surgical Directorates at Ninewells Hospital and Kings Cross Hospital. A random sample of 100 was audited. Case-notes were incomplete for five patients, leaving 95 fully-audited patients. Clinical outcome measures were death from infection, and readmission within 2 weeks of discharge. Initial treatment was inconsistent with antibiotic policy in 46 patients (48%). Antibiotic treatment was changed in 37 (80%) of these patients: increased in intensity in 19 (41%) and decreased in 18 (39%). Changes were also made in 30 (61%) of the 49 patients whose initial treatment was consistent with sepsis policy-increased in seven (14%) and decreased in 23 (47%). Median daily antibiotic costs were lowered in patients whose initial treatment was consistent with sepsis policy (pounds 10.10 vs. pounds 7.28, p = 0.0274). However, in the other patients, savings were balanced by increases (p = 0.7696). Consultation required one consultant session per week (3.5 h) and the audit required an additional 16 consultant sessions. Seven patients died, but only one death was directly related to infection. Six patients were readmitted to hospital within 2 weeks, in three due to recurrence of infection. Changes to treatment were recommended in the majority of patients, regardless of whether initial treatment complied with the sepsis policy. The service primarily redistributed resources rather than reducing costs. A fully audited service requires considerable consultant time, but we believe such time is well spent.
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