Risk of Clostridium difficile Infection in Hospitalized Patients Receiving Metronidazole for a Non–C difficile Infection

Rodríguez, Sandra; Hernandez, Marlow; Tarchini, Giorgio; Zaleski, Megan; Vatanchi, Marjon; Cardona, Lyssette; Castro-Pavia, Fernando; Schneider, Alison

doi:10.1016/j.cgh.2014.02.040

Cited by 22 publications

(13 citation statements)

References 31 publications

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“…We have identified a subset of this population, namely those with low albumin, prior CDI, or receipt of cytarabine-based chemotherapy, who can be identified at time of hospital admission as being especially high-risk for CDI. Recently, metronidazole prophylaxis has been proposed as a possible strategy for CDI prevention, however data specifically looking at patients with malignancies has not been supportive of prophylactic antibiotic treatment to prevent CDI[24,25]. In addition, the anti-toxin monoclonal antibody bezlotoxumab was recently approved by the FDA, and a toxoid vaccine in phase III clinical study is likely to be available soon[26,27].…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Clostridium difficile infection in patients hospitalized with myelodysplastic syndrome or acute myelogenous leukemia

Shah

Curtin

Chu

et al. 2017

WJCO

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AIMTo evaluate factors associated with Clostridium difficile infection (CDI) and outcomes of CDI in the myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) population.METHODSAfter IRB approval, all MDS/AML patients hospitalized at the University of Maryland Greenebaum Comprehensive Cancer Center between August 2011 and December 2013 were identified. Medical charts were reviewed for demographics, clinical information, development of CDI, complications of CDI, and mortality. Patients with CDI, defined as having a positive stool PCR done for clinical suspicion of CDI, were compared to those without CDI in order to identify predictors of disease. A t-test was used for comparison of continuous variables and chi-square or Fisher’s exact tests were used for categorical variables, as appropriate.RESULTSTwo hundred and twenty-three patients (60.1% male, mean age 61.3 years, 13% MDS, 87% AML) had 594 unique hospitalizations during the study period. Thirty-four patients (15.2%) were diagnosed with CDI. Factors significantly associated with CDI included lower albumin at time of hospitalization (P < 0.0001), prior diagnosis of CDI (P < 0.0001), receipt of cytarabine-based chemotherapy (P = 0.015), total days of neutropenia (P = 0.014), and total days of hospitalization (P = 0.005). Gender (P = 0.10), age (P = 0.77), proton-pump inhibitor use (P = 0.73), receipt of antibiotics (P = 0.66), and receipt of DNA hypomethylating agent-based chemotherapy (P = 0.92) were not significantly associated with CDI.CONCLUSIONCDI is common in the MDS/AML population. Factors significantly associated with CDI in this population include low albumin, prior CDI, use of cytarabine-based chemotherapy, and prolonged neutropenia. In this study, we have identified a subset of patients in which prophylaxis studies could be targeted.

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Section: Discussionmentioning

confidence: 99%

Characteristics of Clostridium difficile infection in patients hospitalized with myelodysplastic syndrome or acute myelogenous leukemia

Shah

Curtin

Chu

et al. 2017

WJCO

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“…27 Metronidazole, is often used as a treatment for C. dificile infection and in some instances has been shown to reduce the risk of C. dificile diarrhea when used to treat non-C. dificile infections. 28 Metronidazole, however, has its own set of rare but serious side effects including convulsive seizures, encephalopathy, aseptic meningitis, optic and peripheral neuropathy 29 though most resolve upon cessation of antibiotic therapy. Administration of these antibiotics should be based on laboratory evidence.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic usage for rotaviral diarrhea among children in Libya

Alkoshi

Ernst

Dahlui

2016

Int J Community Med Public Health

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In Libya, most health service sectors are publicly owned and provide preventive, curative and rehabilitation services to all citizens free of charge under supervision of ABSTRACT Background: In Libya, routine access to rotavirus testing is not available and clinicians treat presumptively, leading to inappropriate treatments. This study describes the management of rotavirus infection among Libyan children in public hospitals. Methods: A prospective cross-sectional study was conducted to describe the management of rotavirus among children in three public hospitals in Libya from August 2012 to April 2013. We reviewed internal documents to determine if protocols were in place to guide management of diarrheal illness. Children under five presenting with diarrhea had stool samples collected and tested for rotavirus. Comparisons of treatments were made by rotavirus status and level of dehydration; mild, moderate and severe. Results: A total of 545 diarrhea patients below 5 years of age were enrolled in the study. Of those, 311 (57%) cases were infected by rotavirus. Treatment was administered without investigating the cause of diarrhea. Intravenous fluids (IVF) treatment was the most common treatment for rotavirus cases and was administered to 306 (98%) of cases. Antibiotics were administered to about 137 (44%) of rotavirus cases. Antibiotics were more likely to be administered with more severe dehydration. Conclusions: Presumptive treatment with antibiotics was very common in Libyan. Protocols for management of diarrheal illness and rotavirus cases in children need to be established for effective treatment.

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“…Even metronidazole, a therapeutic drug for CDI that had been considered for prophylaxis for CDI in high risk patients [ 26 ], might not be free of risk because its use has been associated with CDI relapse (odds ratio, 2.74) [ 27 ]. Another finding arguing against the preventive potential of metronidazole is the occurrence of CDI after the administration of a triple metronidazole-containing regimen to eradicate Helicobacter pylori [ 28 ].…”

Section: Antibiotic Exposure Related To the Development Of mentioning

confidence: 99%

Doxycycline and Tigecycline: Two Friendly Drugs with a Low Association with Clostridium Difficile Infection

et al. 2015

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Clostridium difficile infection (CDI) is known to be associated with prior exposure to many classes of antibiotics. Standard therapy for CDI (i.e., metronidazole and vancomycin) is associated with high recurrence rates. Although tetracycline derivatives such as tetracycline, doxycycline or tigecycline are not the standard therapeutic choices for CDI, they may serve as an alternative or a component of combination therapy. Previous tetracycline or doxycycline usage had been shown to have less association with CDI development. Tigecycline, a broad-spectrum glycylcycline with potency against many gram-positive or gram-negative pathogens, had been successfully used to treat severe or refractory CDI. The in vitro susceptibility of C. difficile clinical isolates to tigecycline in many studies showed low minimal inhibitory concentrations. Tigecycline can suppress in vitro toxin production in both historical and hypervirulent C. difficile strains and reduce spore production in a dose-dependent manner. Tetracycline compounds such as doxycycline, minocycline, and tigecycline possess anti-inflammatory properties that are independent of their antibiotic activity and may contribute to their therapeutic effect for CDI. Although clinical data are limited, doxycycline is less likely to induce CDI, and tigecycline can be considered one of the therapeutic choices for severe or refractory CDI.

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Risk of Clostridium difficile Infection in Hospitalized Patients Receiving Metronidazole for a Non–C difficile Infection

Cited by 22 publications

References 31 publications

Characteristics of Clostridium difficile infection in patients hospitalized with myelodysplastic syndrome or acute myelogenous leukemia

Characteristics of Clostridium difficile infection in patients hospitalized with myelodysplastic syndrome or acute myelogenous leukemia

Antibiotic usage for rotaviral diarrhea among children in Libya

Doxycycline and Tigecycline: Two Friendly Drugs with a Low Association with Clostridium Difficile Infection

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