Assessment of 30-day all-cause mortality in metronidazole-treated patients with Clostridium difficile infection

Abstract

The Society for Healthcare Epidemiology (SHEA) and the Infectious Diseases Society of America (IDSA) clinical practice guidelines for Clostridium difficile infection (CDI) help to define and make recommendations for the treatment of mild to moderate disease with metronidazole and severe disease with vancomycin. We retrospectively evaluated 285 patients who were initially treated with metronidazole and stratified them by severity of illness using the guideline criteria. We compared the outcomes in the 2 groups including the need to change therapy, recurrences, and 30-day all-cause mortality. There were no differences in recurrence rates based on severity of disease. From the multivariate analysis, severe CDI was predictive of 30-day all-cause mortality (odds ratio (OR) 1.98, 95% confidence interval (CI) 1.07-3.67, p = 0.03), after controlling for ICU stay prior to diagnosis (OR 2.94, 95% CI 1.60-5.41. p = 0.001), age (OR 1.02, 95% CI 1.004-1.05, p = 0.02), and the modified Charlson score (OR 1.31, 95% CI 1.14-1.49, p < 0.0001).

A meta-analysis of metronidazole and vancomycin for the treatment of Clostridium difficile infection, stratified by disease severity

“…Venugopal et al demonstrated that patients with severe CDI were more prone to switch to vancomycin, suggesting that these patients were responding poorly to metronidazole. 29 These results were confirmed in the current meta-analysis. Treatment outcomes with metronidazole was poor because blood flow to the colon in patients with severe disease could have decreased resulting in less transudation of metronidazole into the lumen.…”

Recurrent Clostridium difficile infection: From colonization to cure

“…Of note, severity of the preceding infection does not appear to impact risk of subsequent recurrence. One observational study found that while RCDI was associated with more severe abdominal pain at onset the infection itself did not worsen with subsequent recurrence 72 and others have found that the severity of the preceding infection is not associated with odds of subsequent recurrence 20, 74 .…”

Recurrence and death after Clostridium difficile infection: gender-dependant influence of proton pump inhibitor therapy

“…Over the last years, CDI incidence has increased three to eight times in the USA (Lessa et al 2015 ; Gilca et al 2010 ), along with the risk of complications (Pepin et al 2004 ); in Europe, the rise of an hypervirulent C. difficile strain (027 or NAP1) has been observed, this strain being responsible for more severe clinical forms and more recurrences (Davies et al 2014 ; Loo et al 2005 ). CDI has various clinical forms, from relatively benign afebrile or febrile diarrhea, to simple colitis, pseudomembranous colitis, severe sepsis, toxic megacolon, and organ perforation; mortality rate of severe form reaches 50 % (Venugopal et al 2013 ). Classical risk factors of CDI are recent hospitalization, antibiotic prescription, age over 65 years, and immunosuppression (Pacheco and Johnson 2013 ).…”