Clinical Efficacy of Therapeutic Agents for <i>Clostridioides difficile</i> Infection Based on Four Severity Classifications

  • Ohtani Mariko
    Department of Pharmacy, Toho University Omori Medical Center, Japan Department of Infection Control and Prevention, Toho University Omori Medical Center, Japan
  • Yoshizawa Sadako
    Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Japan Department of Clinical Laboratory, Toho University Omori Medical Center, Japan
  • Miyazaki Taito
    Department of Infection Control and Prevention, Toho University Omori Medical Center, Japan General Medicine and Emergency Center, Toho University Omori Medical Center, Japan
  • Kumade Eri
    Department of Internal Medicine, Shonan Hospital, Japan
  • Hirayama Shinobu
    Department of Pharmacy, Toho University Omori Medical Center, Japan Department of Infection Control and Prevention, Toho University Omori Medical Center, Japan
  • Sakamoto Maki
    Department of Pharmacy, Toho University Omori Medical Center, Japan Department of Infection Control and Prevention, Toho University Omori Medical Center, Japan
  • Murakami Hinako
    Department of Infection Control and Prevention, Toho University Omori Medical Center, Japan Department of Clinical Laboratory, Toho University Omori Medical Center, Japan
  • Maeda Tadashi
    Department of Infection Control and Prevention, Toho University Omori Medical Center, Japan General Medicine and Emergency Center, Toho University Omori Medical Center, Japan
  • Ishii Yoshikazu
    Department of Infection Control and Prevention, Toho University Omori Medical Center, Japan Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Japan
  • Matsumoto Takahiro
    Department of Pharmacy, Toho University Omori Medical Center, Japan
  • Tateda Kazuhiro
    Department of Infection Control and Prevention, Toho University Omori Medical Center, Japan Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Japan Department of Clinical Laboratory, Toho University Omori Medical Center, Japan

抄録

<p>The Japanese guidelines for the management of Clostridioides difficile infection (CDI) recommend metronidazole (MNZ) for non-severe cases and vancomycin (VCM) for severe cases. Here, we investigated the use of CDI antimicrobials and evaluated their clinical efficacy in four severity classifications and the validity of these classifications. A retrospective chart review was conducted on 137 inpatients with an initial positive C. difficile toxin test and initiation of CDI antimicrobials between April 2015 and March 2019. For the clinical efficacy analysis of the CDI antimicrobials and validation of the severity classifications, patients treated with VCM or oral MNZ were included. The endpoints were CDI recurrence rate, 30-day mortality rate, and diarrhea cure rate. No significant differences were found between the VCM and oral MNZ groups regarding the CDI recurrence rate (10.4% vs. 12.7%, p = 0.707), 30-day mortality rate (12.5% vs. 5.6%, p = 0.162), and diarrhea cure rate (61.9% vs. 72.7%, p = 0.238), regardless of the severity. Treatment with oral MNZ for non-severe cases was promising, confirming the usefulness of treatment according to Japanese guidelines. Further investigation of the clinical efficacy of oral MNZ in patients with first-episode CDI and evaluation of the preferable severity classification are warranted.</p>

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