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Lack of association of outcomes with treatment duration and microbiologic susceptibility data in Clostridium difficile infections in a non-NAP1/BI/027 setting.
Scand J Infect Dis. 2012 Apr; 44(4):243-9.SJ

Abstract

BACKGROUND

Concerns regarding the poor response of severe Clostridium difficile infection (CDI) treated with metronidazole have arisen over the last 5 y.

METHODS

We conducted a prospective, non-interventional study of CDI cases at our institution to evaluate the role of drug resistance, co-morbidities, and the emergence of hypervirulent strains on patient outcomes. A total of 118 adult inpatients with diarrhea and a positive stool for C. difficile toxin immunoassay had positive stool cultures and were included in the study. All 118 isolates had vancomycin and metronidazole susceptibility testing via the E-test method; rep-PCR was performed on 47 isolates. Of the 118 study patients, 107 were treated with either metronidazole or vancomycin.

RESULTS

Initial therapy was metronidazole in 98.1% (n = 105) and vancomycin in 1.9% (n = 2) patients. Evaluable clinical response within 5 days of treatment was noted in 52.5% (52/99) of cases. The mean duration of treatment was 11.7 ± 7.2 days. The 30-day all-cause mortality rate was 24.6% (29/118). Recurrence occurred in 23.6% (21/89). A recent stay in the intensive care unit was associated with increased 30-day mortality (odds ratio 3.58, p = 0.012). There were no isolates resistant to metronidazole or vancomycin. Only 1 isolate was possibly related to the NAP1/BI/027 reference strain. No strain-related differences in deaths or recurrence were noted.

CONCLUSIONS

Deaths related to CDI in our study appear to be related to multiple factors and did not appear to be independently related to antibiotic susceptibility, strain type, or treatment duration.

Authors+Show Affiliations

Division of Infectious Diseases and Department of Medicine, St John Hospital and Medical Center, MI 48236, USA. anilrudh.venugopal@stjohn.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22077148

Citation

Venugopal, Anilrudh A., et al. "Lack of Association of Outcomes With Treatment Duration and Microbiologic Susceptibility Data in Clostridium Difficile Infections in a non-NAP1/BI/027 Setting." Scandinavian Journal of Infectious Diseases, vol. 44, no. 4, 2012, pp. 243-9.
Venugopal AA, Riederer K, Patel SM, et al. Lack of association of outcomes with treatment duration and microbiologic susceptibility data in Clostridium difficile infections in a non-NAP1/BI/027 setting. Scand J Infect Dis. 2012;44(4):243-9.
Venugopal, A. A., Riederer, K., Patel, S. M., Szpunar, S., Jahamy, H., Valenti, S., Shemes, S. P., Khatib, R., & Johnson, L. B. (2012). Lack of association of outcomes with treatment duration and microbiologic susceptibility data in Clostridium difficile infections in a non-NAP1/BI/027 setting. Scandinavian Journal of Infectious Diseases, 44(4), 243-9. https://doi.org/10.3109/00365548.2011.631029
Venugopal AA, et al. Lack of Association of Outcomes With Treatment Duration and Microbiologic Susceptibility Data in Clostridium Difficile Infections in a non-NAP1/BI/027 Setting. Scand J Infect Dis. 2012;44(4):243-9. PubMed PMID: 22077148.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Lack of association of outcomes with treatment duration and microbiologic susceptibility data in Clostridium difficile infections in a non-NAP1/BI/027 setting. AU - Venugopal,Anilrudh A, AU - Riederer,Kathleen, AU - Patel,Shilpa M, AU - Szpunar,Susanna, AU - Jahamy,Houssein, AU - Valenti,Sharon, AU - Shemes,Stephen P, AU - Khatib,Riad, AU - Johnson,Leonard B, Y1 - 2011/11/13/ PY - 2011/11/15/entrez PY - 2011/11/15/pubmed PY - 2012/9/20/medline SP - 243 EP - 9 JF - Scandinavian journal of infectious diseases JO - Scand J Infect Dis VL - 44 IS - 4 N2 - BACKGROUND: Concerns regarding the poor response of severe Clostridium difficile infection (CDI) treated with metronidazole have arisen over the last 5 y. METHODS: We conducted a prospective, non-interventional study of CDI cases at our institution to evaluate the role of drug resistance, co-morbidities, and the emergence of hypervirulent strains on patient outcomes. A total of 118 adult inpatients with diarrhea and a positive stool for C. difficile toxin immunoassay had positive stool cultures and were included in the study. All 118 isolates had vancomycin and metronidazole susceptibility testing via the E-test method; rep-PCR was performed on 47 isolates. Of the 118 study patients, 107 were treated with either metronidazole or vancomycin. RESULTS: Initial therapy was metronidazole in 98.1% (n = 105) and vancomycin in 1.9% (n = 2) patients. Evaluable clinical response within 5 days of treatment was noted in 52.5% (52/99) of cases. The mean duration of treatment was 11.7 ± 7.2 days. The 30-day all-cause mortality rate was 24.6% (29/118). Recurrence occurred in 23.6% (21/89). A recent stay in the intensive care unit was associated with increased 30-day mortality (odds ratio 3.58, p = 0.012). There were no isolates resistant to metronidazole or vancomycin. Only 1 isolate was possibly related to the NAP1/BI/027 reference strain. No strain-related differences in deaths or recurrence were noted. CONCLUSIONS: Deaths related to CDI in our study appear to be related to multiple factors and did not appear to be independently related to antibiotic susceptibility, strain type, or treatment duration. SN - 1651-1980 UR - https://www.unboundmedicine.com/medline/citation/22077148/Lack_of_association_of_outcomes_with_treatment_duration_and_microbiologic_susceptibility_data_in_Clostridium_difficile_infections_in_a_non_NAP1/BI/027_setting_ L2 - https://www.tandfonline.com/doi/full/10.3109/00365548.2011.631029 DB - PRIME DP - Unbound Medicine ER -