Diferencias entre las recomendaciones y la práctica clínica en la infección por Clostridium difficile

Clostridioides difficile infection treatment guidelines adherence and comparison of treatment outcomes of the first, non-severe disease episode between oral metronidazole and vancomycin group: a single tertiary center retrospective study

“…In comparison to the previous studies, in which adherence of the initial CDI treatment to the treatment guidelines ranged from 40.2 -54.0% [3][4][5][6], in our tertiary care center specialized in infectious diseases the higher, but stil unsatisfactory adherence of 61% has been recorded.…”

“…Studies analysing the gudelines adherence reported mostly its decrease with increase of disease severity [4,6], and the adherence as low as 8.5% in a group of severe CDI [4], along with adherence of 16.6% in a group of fulminant CDI has been reported [5]. In a study from USA that analyzed patient factors which indicate provider's nonadherence to an institutional CDI treatment guidelines, bivariate analyses associated 5 factors with nonadherence: older age, ICU admission, duration of antibiotics and mild/moderate and severe infection (all p<.05), and in the logistic regression model, severe infection (p<.001) was independently associated with guideline nonadherence [6], which suggests disregarding of disease-severity criteria while choosing initial CDI therapy.…”

“…The impaired clinical outcomes due to disregard of CDI treatment guidelines, especially among more severe ill patients, have been observed by numerous studies [3,5]. The disease outcomes can be influenced by many predisponing factors existing in a patient, and by clinical burden of the disease per se, but the negative clinical impact of the initial undertreatment of CDI infection should also be taken into the consideration.…”

“…Management guidelines [1,2] were established in order to reduce morbidity and mortality of C. difficile infection (CDI) and their non-observance has been associated with poorer clinical outcomes [3]. The reported overall adherences are low [3][4][5][6], often even under 50% of CDI cases, and factors influencing therapeutical decisions being discordant to the guidelines are insufficiently explored.…”

A Comparison of Current Guidelines of Five International Societies on Clostridium difficile Infection Management

“…The consequence of this situation is the coexistence of guidelines with certain differences in their recommendations that may raise doubts in the minds of treating physicians at the time of clinical decision making [ 14 ]. This insecurity, in turn, may also contribute to the low adherence to existing guidelines observed in various studies [ 15 – 17 ]. Indeed, an elevated proportion of clinicians agree on the main points where current CDI management practices could and should be improved [ 18 ].…”