Lack of Benefit With Combination Therapy for Clostridium difficile Infection

2017 ◽  
Vol 38 (5) ◽  
pp. 602-605
Author(s):  
Jessica C. Njoku ◽  
Trevor C. Van Schooneveld ◽  
Mark E. Rupp ◽  
Keith M. Olsen ◽  
Fang Qiu ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Combination Therapy ◽  
Confidence Interval ◽  
Clinical Outcomes ◽  
Clostridium Difficile Infection ◽  
Infect Control Hosp ◽  
Limited Data ◽  
Duration Of Therapy ◽  
Prolonged Duration

Limited data exist regarding combination therapy for Clostridium difficile infection (CDI). After adjusting for confounders in a cohort of patients with CDI and≥1 year old, combination therapy was not associated with significant differences in clinical outcomes, but it was associated with prolonged duration of therapy (1.22 days; 95% confidence interval, 1.03–1.44 days; P=.02).Infect Control Hosp Epidemiol 2017;38:602–605

scholarly journals Incidence and Clinical Outcomes of Clostridium difficile Infection after Treatment with Tuberculosis Medication

Gut and Liver ◽  
2016 ◽  
Vol 10 (2) ◽  
pp. 250 ◽  
Author(s):  
Yu Mi Lee ◽  
Kyu Chan Huh ◽  
Soon Man Yoon ◽  
Byung Ik Jang ◽  
Jeong Eun Shin ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Clinical Outcomes ◽  
Clostridium Difficile Infection

scholarly journals What Is the Role for Metronidazole in the Treatment of Clostridium difficile Infection? Results From a National Cohort Study of Veterans With Initial Mild Disease

2018 ◽  
Vol 69 (8) ◽  
pp. 1288-1295 ◽  
Author(s):  
Haley J Appaneal ◽  
Aisling R Caffrey ◽  
Kerry L LaPlante
Keyword(s):  
Clostridium Difficile ◽  
Clinical Outcomes ◽  
Clostridium Difficile Infection ◽  
Proportional Hazards ◽  
Therapeutic Option ◽  
Cox Proportional Hazards ◽  
First Episode ◽  
Mild Disease ◽  
All Cause Mortality ◽  
National Cohort

Abstract Background Metronidazole may still be an appropriate therapeutic option for mild Clostridium difficile infection (CDI) in select patients, but data are limited to guide clinicians in identifying these patients. Methods Our 2-stage study included a national cohort of Veterans with a first episode of mild CDI (2010–2014). First, among those treated with metronidazole, we identified predictors of success, defined as absence of all-cause mortality or recurrence 30 days posttreatment, using multivariable unconditional logistic regression. Second, among a subgroup of patients with characteristics predictive of success identified in the first stage, we compared clinical outcomes among those treated with metronidazole compared with vancomycin, using Cox proportional hazards models for time to 30-day all-cause mortality, CDI recurrence, and failure. Results Among 3656 patients treated with metronidazole, we identified 3282 patients with success and 374 patients without success (failure). Younger age was the only independent predictor of success. Age ≤65 years was associated with an odds of success 1.63 times higher (95% confidence interval [CI], 1.29–2.06) than age >65 years. Among 115 propensity score–matched pairs ≤65 years of age, no significant differences were observed between metronidazole and vancomycin (reference) for all-cause mortality (hazard ratio [HR], 0.29 [95% CI, .06–1.38]), CDI recurrence (HR, 0.62 [95% CI, .26–1.49]), or failure (HR, 0.50 [95% CI, .23–1.07]). Conclusions Among patients ≤65 years of age with initial mild CDI, clinical outcomes were similar with metronidazole and vancomycin. These data suggest that metronidazole may be considered for the treatment of initial mild CDI among patients 65 years of age or younger.

Electronic Clostridium difficile Infection Bundle Reduces Time to Initiation of Contact Precautions

2016 ◽  
Vol 38 (2) ◽  
pp. 242-244 ◽  
Author(s):  
Courtney M. Dewart ◽  
Natalia Blanco ◽  
Betsy Foxman ◽  
Anurag N. Malani
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Infect Control Hosp ◽  
Contact Precaution ◽  
Order Entry ◽  
Contact Precautions ◽  
Computerized Order Entry ◽  
Time To Initiation ◽  
The Impact ◽  
Reduced Time

The impact of computerized order-entry bundles on timing of contact precaution initiation for C. difficile infection (CDI) remains largely unexplored. Implementation of an electronic CDI prevention and management bundle that included an automatic isolation component significantly reduced time to initiation of contact precautions from 33.7 to 22.4 hours.Infect Control Hosp Epidemiol 2016;242–244

Clostridium difficile treatment in neutropenic patients: Clinical outcomes of metronidazole, vancomycin, combinations, and switch therapy

2017 ◽  
Vol 25 (3) ◽  
pp. 520-528 ◽  
Author(s):  
Jennifer D Tieu ◽  
Sarah A Schmidt ◽  
Jamie L Miller ◽  
Katherine E Kupiec ◽  
Grant H Skrepnek ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Combination Therapy ◽  
Clinical Outcomes ◽  
Cox Regression ◽  
Treatment Guidelines ◽  
Severe Disease ◽  
Surrogate Marker ◽  
Oral Vancomycin ◽  
Switch Therapy ◽  
Neutropenic Patients

Background Clostridium difficile infection treatment guidelines exist for immunocompetent patients; however, there is a paucity of data evaluating clinical outcomes and time to C. difficile-associated diarrhea resolution in neutropenic patients. Objective To assess clinical outcomes in neutropenic patients treated with metronidazole, oral vancomycin, the combination of metronidazole plus oral vancomycin, and switch of metronidazole to oral vancomycin. Methods This retrospective, observational cohort study assessed adult neutropenic inpatients with C. difficile-associated diarrhea treated with metronidazole, oral vancomycin, combination (metronidazole and oral vancomycin), or switch therapy (metronidazole to oral vancomycin). The primary outcome was time to diarrhea resolution based on treatment regimen. Secondary outcomes included C. difficile-associated diarrhea resolution of diarrhea by day 14, recurrence, and occurrence of major complications. Results Overall, 44 patients met full inclusion criteria (52.2% metronidazole monotherapy, 22.7% combination, and 25.0% switch therapy). Two patients on oral vancomycin monotherapy were excluded due to insufficient sample size. Overall time to C. difficile-associated diarrhea resolution was 9.1 ± 10.7 days. The Cox regression results suggested both switch and combination therapy were associated with 65.5% (p = 0.002) and 65.9% (p = 0.046) longer time to C. difficile-associated diarrhea resolution compared to metronidazole monotherapy, respectively. An increasing absolute neutrophil count was associated with an increase in C. difficile-associated diarrhea resolution (p = 0.007). Conclusion Switch or combination therapy was associated with a prolonged time to C. difficile-associated diarrhea resolution. The decision to use switch or combination therapy may represent a surrogate marker for more severe disease and need for therapy escalation. It is unknown if initial therapy with oral vancomycin would provide better outcomes as this could not be assessed.

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