A Prospective Study of Risk Factors and Historical Trends in Metronidazole Failure for Clostridium difficile Infection

Hu, Mary; Maroo, Seema; Kyne, Lorraine; Cloud, Jeffrey; Tummala, Sanjeev; Katchar, Kianoosh; Dreisbach, Valley; Noddin, Laura; Kelly, Ciarán P.

doi:10.1016/j.cgh.2008.06.024

Cited by 27 publications

(23 citation statements)

References 24 publications

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“…A recent prospective study of hospitalized patients (without IBD) showed a high failure rate with metronidazole treatment for C. diffi cile in patients who had been recently treated with cephalosporins, in those who were positive for C. diffi cile on admission, and in those transferred from another hospital. In such cases, therefore, vancomycin should be considered as the preferred initial antibiotic ( 254 ).…”

Section: The Patient With Severe Colitis Refractory To Maximal Oral Tmentioning

confidence: 99%

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Kornbluth

Sachar

2010

American Journal of Gastroenterology

1,141

977

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Guidelines for clinical practice are aimed to indicate preferred approaches to medical problems as established by scientifi cally valid research. Double-blind placebo controlled studies are preferable, but compassionate-use reports and expert review articles are used in a thorough review of the literature conducted through Medline with the National Library of Medicine. When only data that will not withstand objective scrutiny are available, a recommendation is identifi ed as a consensus of experts. Guidelines are applicable to all physicians who address the subject regardless of specialty training or interests and are aimed to indicate the preferable but not necessarily the only acceptable approach to a specifi c problem. Guidelines are intended to be fl exible and must be distinguished from standards of care, which are infl exible and rarely violated. Given the wide range of specifi cs in any healthcare problem, the physician must always choose the course best suited to the individual patient and the variables in existence at the moment of decision. Guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee and approved by the board of trustees. Each has been intensely reviewed and revised by the Committee, other experts in the fi eld, physicians who will use them, and specialists in the science of decision analysis. The recommendations of each guideline are therefore considered valid at the time of composition based on the data available. New developments in medical research and practice pertinent to each guideline will be reviewed at a time established and indicated at publication to assure continued validity. The recommendations made are based on the level of evidence found. Grade A recommendations imply that there is consistent level 1 evidence (randomized controlled trials), grade B indicates that the evidence would be level 2 or 3, which are cohort studies or case -control studies. Grade C recommendations are based on level 4 studies, meaning case series or poor-quality cohort studies, and grade D recommendations are based on level 5 evidence, meaning expert opinion.

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Section: The Patient With Severe Colitis Refractory To Maximal Oral Tmentioning

confidence: 99%

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Kornbluth

Sachar

2010

American Journal of Gastroenterology

1,141

977

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“…infection with the epidemic nAP-1 strain was not associated with metronidazole failure in endemic cDi. 22 continued use of non-C. difficile antibiotics after diagnosis of cDi, concomitant prescription of antacid medications, and older age were significantly associated with increased risk of recurrent cDi. 15 Evidence for the association between C. difficile and the use of PPis is unclear.…”

Section: Discussionmentioning

confidence: 97%

Clinical risk factors for Clostridium difficile-associated diseases

Cho¹,

Lee²,

Yoon³

2012

Braz J Infect Dis

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A b s t r A c t Many factors appear to influence the chance of acquiring Clostridium difficile (c. difficile)infection, and an accurate identification of risk factors could be beneficial in many ways.thus, in the present study, clinical risk factors for c. difficile-associated disease (cDAD) in Korea were identified. A total of 93 patients who met the inclusion criteria and 186 age/gender/ward/admission period-matched control patients were included in this study. (or, 14.90; 95% ci, 4.02-55.26; p < 0.001). Awareness of cDAD is critical to provide appropriate clinical care. surveillance of the national incidence rate and multicenter studies are needed, and the potential value of a c. difficile vaccine should be studied.

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“…Table 1 shows the main characteristics of the included studies. The majority of the studies were conducted in North America (n = 26) [13,14,[16][17][18][19][20]23,[25][26][27]31,33,34,38,40,41,[43][44][45][46][47][48][49][50][51], whilst 7 were conducted in Europe (mainly in the UK) [21,22,[28][29][30]32,35]. One more study included patients from North America and the UK [15], four from Asia (South Korea and Taiwan) [36,37,39,42] and one from Argentina [24].…”

Section: Data Synthesis and Analysismentioning

confidence: 99%

“…Amongst 1669 articles retrieved through electronic and reference list searches, 39 articles were selected as evaluable for inclusion in the systematic review . More specifically, 7 RCTs (1214 patients) [13][14][15][16][17][18][19], 11 prospective studies (1057 patients) [20][21][22][23][24][25][26][27][28][29][30] and 21 retrospective studies (4734 patients) were identified. A total of 7005 patients were studied.…”

Section: Data Synthesis and Analysismentioning

confidence: 99%

Treatment failure and recurrence of Clostridium difficile infection following treatment with vancomycin or metronidazole: a systematic review of the evidence

Vardakas

Polyzos

Patouni

et al. 2012

International Journal of Antimicrobial Agents

223

162

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A Prospective Study of Risk Factors and Historical Trends in Metronidazole Failure for Clostridium difficile Infection

Abstract: Background & Aims-Recent studies of C. difficile infection (CDI) indicate a dramatic increase in metronidazole failure. The aims of this study were to compare current and historical rates of metronidazole failure and identify risk factors for metronidazole failure.

Cited by 27 publications

References 24 publications

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Clinical risk factors for Clostridium difficile-associated diseases

Treatment failure and recurrence of Clostridium difficile infection following treatment with vancomycin or metronidazole: a systematic review of the evidence

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