The effect of concomitant use of systemic antibiotics in patients with Clostridium difficile infection receiving metronidazole therapy

Management of Clostridium difficile infection (CDI) involves discontinuation of the offending antibiotic agent as soon as possible. However, the ongoing infection does not allow discontinuation of the offending antibiotic. We aimed to retrospectively investigate the predictors of treatment failure a...

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Bibliographic Details
Published in:Epidemiology and infection 2018-04, Vol.146 (5), p.558-564
Main Authors: Jin, S.J., Seo, K.H., Wi, Y.M.
Format: Article
Language:English
Subjects:
Aged
Anti-Bacterial Agents - therapeutic use
Antibiotics
Antimicrobial agents
Bacteria
Chemotherapy
Clinical medicine
Clostridium difficile
Clostridium difficile - drug effects
Clostridium Infections - drug therapy
Clostridium Infections - mortality
Cohort Studies
Dialysis
Diarrhea
Enzyme immunoassay
Family medical history
Female
Fever
Gastrointestinal Infection
Hospitals
Humans
Immunoassay
Infections
Infectious diseases
Internal medicine
Laboratories
Male
Medicine
Metronidazole
Metronidazole - therapeutic use
Middle Aged
Morbidity
Mortality
Multivariate analysis
Original Paper
Patients
Receiving waters
Republic of Korea - epidemiology
Retrospective Studies
Serum albumin
Studies
Systematic review
Therapy
Treatment Failure
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Summary:Management of Clostridium difficile infection (CDI) involves discontinuation of the offending antibiotic agent as soon as possible. However, the ongoing infection does not allow discontinuation of the offending antibiotic. We aimed to retrospectively investigate the predictors of treatment failure and impact of the concomitant use of systemic antibiotics in patients receiving metronidazole therapy. This study was conducted among patients hospitalised at a second care academic hospital from January 2013 to December 2014. Eligible patients were identified by reviewing stool toxin enzyme immunoassay results for C. difficile. Diarrhoea was defined as the passage of at least three loose or watery stools within 24 h. Among 314 patients with CDI receiving metronidazole therapy, 62 (19.7%) showed treatment failure and 105 (33.4%) received concomitant antibiotics. Underlying dialysis, fever >38.3 °C, low median serum albumin levels and concomitant use of antibiotics were independent predictors of treatment failure in patients with CDI receiving metronidazole therapy. The concomitant use of antibiotics increased the rates of treatment failure and 30-day mortality in patients receiving metronidazole therapy. These results suggest that metronidazole should be used in mild cases of CDI only after discontinuation of the offending antibiotics.
ISSN:0950-2688
1469-4409
DOI:10.1017/S0950268818000390