Reappraisal of the clinical role of metronidazole therapy for Clostridioides difficile infection in Taiwan: A multicenter prospective study

Lee, Jen-Chieh; Lee, Ching Chi; Chiu, Chun-Wei; Tsai, Pei-Jane; Hsueh, Po‐Ren; Lee, Yuan‐Ti; Hung, Yuan‐Pin; Ko, Wen–Chien

doi:10.1016/j.jfma.2022.07.004

Cited by 2 publications

(1 citation statement)

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“…In addition, the authors only reported the imprecise methodology of "usually" used doses of metronidazole, vancomycin and fidaxomicin for the treatment of CDID, thus not clearly differentiating the study sample in relation to the concordance of the administered treatment compared to our study [57]. Other authors reported associations between just one criterion from the two currently recommended, mostly leukocytosis > 15 × 10 9 /L, with outcomes such as treatment failure, recurrent CDID and 30-day all-cause mortality [19,58]. Thus, our hypothesis and the first objective have arisen from the need to identify patients with the most severe conditions meeting two criteria of the severe CDID form, including leukocytosis and serum creatinine level above the threshold.…”

Section: Discussionmentioning

confidence: 82%

Improving Clostridioides difficile Infectious Disease Treatment Response via Adherence to Clinical Practice Guidelines

Adukauskienė,

Mickus,

Dambrauskienė

et al. 2024

Antibiotics

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Clostridioides difficile (C. difficile) is a predominant nosocomial infection, and guidelines for improving diagnosis and treatment were published in 2017. We conducted a single-center, retrospective 10-year cohort study of patients with primary C. difficile infectious disease (CDID) at the largest referral Lithuanian university hospital, aiming to evaluate the clinical and laboratory characteristics of CDID and their association with the outcomes, as well as implication of concordance with current Clinical Practice Guidelines. The study enrolled a total of 370 patients. Cases with non-concordant CDID treatment resulted in more CDID-related Intensive Care Unit (ICU) admissions (7.5 vs. 1.8%) and higher CDID-related mortality (13.0 vs. 1.8%) as well as 30-day all-cause mortality (61.0 vs. 36.1%) and a lower 30-day survival compared with CDID cases with concordant treatment (p < 0.05). Among cases defined by two criteria for severe CDID, only patients with non-concordant metronidazole treatment had refractory CDID (68.8 vs. 0.0%) compared with concordant vancomycin treatment. In the presence of non-concordant metronidazole treatment for severe CDID, only cases defined by two severity criteria had more CDID-related ICU admissions (18.8 vs. 0.0%) and higher CDID-related mortality (25.0 vs. 2.0%, p < 0.05) compared with cases defined by one criterion. Severe comorbidities and the continuation of concomitant antibiotics administered at CDID onset reduced (p < 0.05) the 30-day survival and increased (p = 0.053) 30-day all-cause mortality, with 57.6 vs. 10.7% and 52.0 vs. 25.0%, respectively. Conclusions: CDID treatment non-concordant with the guidelines was associated with various adverse outcomes. In CDID with leukocytes ≥ 15 × 109/L and serum creatinine level > 133 µmol/L (>1.5 mg/dL), enteral vancomycin should be used to avoid refractory response, as metronidazole use was associated with CDID-related ICU admission and CDID-related mortality. Severe comorbidities worsened the outcomes as they were associated with reduced 30-day survival. The continuation of concomitant antibiotic therapy increased 30-day all-cause mortality; thus, it needs to be reasonably justified, deescalated or stopped.

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Section: Discussionmentioning

confidence: 82%