Impact of Revised Infectious Diseases Society of America and Society for Healthcare Epidemiology of America Clinical Practice Guidelines on the Treatment of Clostridium difficile Infections in the United States
Impact of Revised Infectious Diseases Society of America and Society for Healthcare Epidemiology of America Clinical Practice Guidelines on the Treatment of Clostridium difficile Infections in the United States
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DOI：
10.1093/cid/ciaa484
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发表时间：
2021-06-01
影响因子：
11.8
通讯作者：
Nguyen, M. Hong
中科院分区：
文献类型：
--
作者：
Clancy, Cornelius J.;Buehrle, Deanna;Nguyen, M. Hong
背景资料。我们的目标是确定在2018年2月修订的艰难梭菌感染(CDI)临床实践指南发布后，美国口服万古霉素、非达克西星和甲硝唑的使用是否发生了变化。我们获得了2006年至2019年8月的美国抗生素处方数据(IQVIA)，并使用指南推荐的剂量方案估计了万古霉素、非达克西星和甲硝唑每月10天的疗程数。进行间断的时间序列分析，按月调整。我们比较了不同时间段每月疗程数的线性趋势。与18个月前相比，口服万古霉素和非达克星的累积疗程分别增加了54%(n=226 166)和48%(n=18518)，口服甲硝唑的累积疗程减少了3%(n=238372)。在修订指南后的整个期间，万古霉素和非达克西星的月度使用量显著增加(P<；.0001和P=.0002)，而甲硝唑的月度使用量显著下降(P<；.0001)。与证实万古霉素优于甲硝唑的临床试验结果(P<；.0001)相比，修订指南公布后，万古霉素月使用量增加，甲硝唑使用量减少幅度更大。修订后的实践指南对美国的CDI治疗产生了重大影响。用于修订指南的临床试验数据分别从2007-2014年和2011-2012年开始提供，分别用于口服万古霉素和非达克索米星。治疗CDI和其他感染的指南或指导文件应更及时地更新。
Background. Our objective was to determine if oral vancomycin, fidaxomicin, and oral metronidazole use in the United States changed after publication of revised clinical practice guidelines for Clostridium difficile infection (CDI) in February 2018.Methods. We obtained US antibiotic prescription data (IQVIA) from 2006-August 2019 and used guideline-recommended dosing regimens to estimate monthly numbers of 10-day treatment courses of vancomycin, fidaxomicin and metronidazole. Interrupted time-series analyses were performed, adjusted by month. We compared linear trends for monthly numbers of treatment courses in different time periods.Results. Cumulative treatment courses of oral vancomycin and fidaxomicin increased by 54% (n = 226 166) and 48% (n = 18 518), respectively, in 18 months following guidelines compared with 18 months before; those of oral metronidazole decreased by 3% (n = 238 372). Monthly vancomycin and fidaxomicin use significantly increased throughout the period following revised guidelines (P < .0001 and P = .0002, respectively), whereas that of metronidazole decreased significantly (P < .0001). Monthly vancomycin use increased and metronidazole use decreased to a significantly greater extent after publication of revised guidelines than after publication of clinical trials establishing superiority of vancomycin over metronidazole (P < .0001).Conclusions. Revised practice guidelines have had a significant impact on CDI treatment in the US. Clinical trial data used for the revised guidelines were available since 2007-2014 and 2011-2012 for oral vancomycin and fidaxomicin, respectively. Guidelines or guidance documents for treating CDI and other infections should be updated in more timely fashion.