1. Potential impact of removing metronidazole from treatment armamentarium of mild acute Clostridioides difficile infection
- Author
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Bethlehem Mengesha, Shani Zilberman-Itskovich, Marina Bondarenco, Limor Toledano, Dror Marchaim, Ilan Youngster, Yael Kachlon, Ronit Zaidenstein, Nathan Strul, and Tsilia Lazarovitch
- Subjects
0301 basic medicine ,Microbiology (medical) ,Potential impact ,medicine.medical_specialty ,genetic structures ,business.industry ,030106 microbiology ,Retrospective cohort study ,biochemical phenomena, metabolism, and nutrition ,Clostridium difficile ,Microbiology ,03 medical and health sciences ,Metronidazole ,Diarrhea ,0302 clinical medicine ,Internal medicine ,medicine ,Antimicrobial stewardship ,Vancomycin ,030212 general & internal medicine ,medicine.symptom ,business ,Clostridioides ,medicine.drug - Abstract
Aim: Recent guidelines recommended removing metronidazole as a therapeutic option for Clostridioides difficile infections (CDI). However, superiority of vancomycin over metronidazole in mild CDI is not established and use of vancomycin might lead to emergence of vancomycin-resistant enterococci (VRE). Patients & methods: A retrospective cohort study and efficacy analyses were conducted at Shamir Medical Center, Israel (2010–2015), among adults with acute CDI. Results: A total of 409 patients were enrolled. In multivariable analyses, metronidazole was noninferior to vancomycin for mild CDI, but vancomycin was an independent predictor for post-CDI VRE acquisition. Conclusion: A significant independent association was evident between treatment with vancomycin and, later, acquisition of VRE. In first episodes of mild acute CDI, metronidazole should be considered a valid therapeutic option.
- Published
- 2019
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