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Metronidazole therapy as initial treatment of Clostridium difficile infection in patients with chronic kidney disease in Korea.
Epidemiol Infect 2019; 147:e289EI

Abstract

The risk of metronidazole treatment failure in Clostridium difficile infection (CDI) patients with chronic kidney disease (CKD) or end-stage renal disease in Korea has not been established. We evaluated 481 patients who had been admitted to two secondary hospitals with a diagnosis of, and treatment for, CDI during 2010-2016. CDI patients were divided into three groups according to CKD status: non-CKD (n = 363), CKD (n = 55) and those requiring dialysis (n = 63). Logistic regression analyses were performed to examine the association of CKD status with treatment failure. CDI patients receiving dialysis tended to have increased odds of metronidazole and overall treatment failure compared to non-CKD patients; adjusted odds ratios and 95% confidence intervals were 2.09 (1.03-4.21) and 2.18 (1.11-4.32) for metronidazole and overall treatment failure, respectively. However, CKD patients did not have increased odds of metronidazole or overall treatment failure compared to non-CKD patients, even where severe CDI was more prevalent in CKD patients. The incidence of symptomatic ileus or toxic megacolon did not differ among groups. Our results suggest that initial metronidazole therapy may be considered in CDI patients with non-dialysis CKD, but should not be considered in CDI patients undergoing dialysis.

Authors+Show Affiliations

Division of Gastroenterology, Department of Medicine, Changwon Fatima Hospital, Changwon, Korea.Division of Infection, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.Division of Nephrology, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31607272

Citation

Shin, Jaeuk, et al. "Metronidazole Therapy as Initial Treatment of Clostridium Difficile Infection in Patients With Chronic Kidney Disease in Korea." Epidemiology and Infection, vol. 147, 2019, pp. e289.
Shin J, Wi YM, Lee YJ. Metronidazole therapy as initial treatment of Clostridium difficile infection in patients with chronic kidney disease in Korea. Epidemiol Infect. 2019;147:e289.
Shin, J., Wi, Y. M., & Lee, Y. J. (2019). Metronidazole therapy as initial treatment of Clostridium difficile infection in patients with chronic kidney disease in Korea. Epidemiology and Infection, 147, pp. e289. doi:10.1017/S0950268819001742.
Shin J, Wi YM, Lee YJ. Metronidazole Therapy as Initial Treatment of Clostridium Difficile Infection in Patients With Chronic Kidney Disease in Korea. Epidemiol Infect. 2019 Oct 14;147:e289. PubMed PMID: 31607272.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Metronidazole therapy as initial treatment of Clostridium difficile infection in patients with chronic kidney disease in Korea. AU - Shin,Jaeuk, AU - Wi,Yu Mi, AU - Lee,Yu-Ji, Y1 - 2019/10/14/ PY - 2019/10/15/entrez PY - 2019/10/15/pubmed PY - 2019/10/15/medline KW - Chronic kidney disease KW - Clostridium difficile KW - dialysis KW - metronidazole KW - treatment failure SP - e289 EP - e289 JF - Epidemiology and infection JO - Epidemiol. Infect. VL - 147 N2 - The risk of metronidazole treatment failure in Clostridium difficile infection (CDI) patients with chronic kidney disease (CKD) or end-stage renal disease in Korea has not been established. We evaluated 481 patients who had been admitted to two secondary hospitals with a diagnosis of, and treatment for, CDI during 2010-2016. CDI patients were divided into three groups according to CKD status: non-CKD (n = 363), CKD (n = 55) and those requiring dialysis (n = 63). Logistic regression analyses were performed to examine the association of CKD status with treatment failure. CDI patients receiving dialysis tended to have increased odds of metronidazole and overall treatment failure compared to non-CKD patients; adjusted odds ratios and 95% confidence intervals were 2.09 (1.03-4.21) and 2.18 (1.11-4.32) for metronidazole and overall treatment failure, respectively. However, CKD patients did not have increased odds of metronidazole or overall treatment failure compared to non-CKD patients, even where severe CDI was more prevalent in CKD patients. The incidence of symptomatic ileus or toxic megacolon did not differ among groups. Our results suggest that initial metronidazole therapy may be considered in CDI patients with non-dialysis CKD, but should not be considered in CDI patients undergoing dialysis. SN - 1469-4409 UR - https://www.unboundmedicine.com/medline/citation/31607272/Metronidazole_therapy_as_initial_treatment_of_Clostridium_difficile_infection_in_patients_with_chronic_kidney_disease_in_Korea L2 - https://www.cambridge.org/core/product/identifier/S0950268819001742/type/journal_article DB - PRIME DP - Unbound Medicine ER -
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