Outcomes associated with recent guideline recommendations removing metronidazole for treatment of non-severe Clostridioides difficile infection: a retrospective, observational, nationwide cohort study
Outcomes associated with recent guideline recommendations removing metronidazole for treatment of non-severe Clostridioides difficile infection: a retrospective, observational, nationwide cohort study
复制标题
DOI：
10.1016/j.ijantimicag.2021.106282
复制
发表时间：
2021-03-10
影响因子：
10.8
通讯作者：
Williams, Riley J., II
中科院分区：
文献类型：
--
作者：
Gentry, Chris A.;Campbell, Darien L.;Williams, Riley J., II
目的：2017年美国医疗保健流行病学学会（SHEA）和美国传染病学会（IDSA）艰难梭菌（C。艰难梭菌）感染（CDI）的治疗中，甲硝唑不再作为非严重CDI初始发作的首选方案。本研究旨在确定停用甲硝唑是否改善了非重度CDI初始发作的临床结局。研究方法：该研究是一项回顾性、观察性、全国性队列研究，使用退伍军人健康管理局国家临床管理数据库。在2017年IDSA/SHEA C于2018年2月发表之前和之后接受非重度CDI治疗的成人患者。纳入了difficile临床实践指南。主要结局是治疗失败或可能复发的复合终点。结果如下：共纳入3608例患者，其中1809例在指南前队列中（平均[SD]年龄，65. 5 [14. 2]岁; 1602例[88. 6%]男性），1799例在指南后队列中（平均[SD]年龄，64 [14. 6]岁; 1584例[88%]男性）。两个队列的治疗失败或可能复发的总体复合终点相似（指南前队列318/1809 [17.6%] vs指南后队列317/1799 [17.6%][ P = 0.97]）。结论：在最初的非严重艰难梭菌感染中，放弃甲硝唑作为首选治疗方案并没有改善治疗失败或复发的复合因素。爱思唯尔有限公司出版
Objectives: The 2017 Society for Healthcare Epidemiology of America (SHEA) and Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for Clostridioides difficile ( C. difficile) infection (CDI) removed metronidazole as a preferred option for initial episodes of non-severe CDI. This study aimed to determine if the shift away from metronidazole improved clinical outcomes of initial episodes of non severe CDI. Methods: The study was a retrospective, observational, nationwide cohort study using a Veterans Health Administration national clinical administrative database. Adult patients treated for non-severe CDI before and after the February 2018 publication of the 2017 IDSA/SHEA C. difficile Clinical Practice Guidelines were included. The primary outcome was the composite of treatment failure or probable recurrence. Results: A total of 3608 patients were included, with 1809 in the pre-guideline cohort (mean [SD] age, 65.5 [14.2] years; 1602 [88.6%] male) and 1799 in the post-guideline cohort (mean [SD] age, 64 [14.6] years; 1584 [88%] male). Overall composite of treatment failure or probable recurrence was similar between both cohorts (318 of 1809 [17.6%] pre-guideline cohort vs. 317 of 1799 [17.6%] post-guideline cohort [ P = 0.97]). Conclusion: The shift away from metronidazole as a preferred option in initial non-severe Clostridioides difficile infection did not improve the composite of treatment failure or recurrence. Published by Elsevier Ltd.