The Addition of Intravenous Metronidazole to Oral Vancomycin is Associated with Improved Mortality in Critically Ill Patients with Clostridium difficile Infection.
Clin Infect Dis. 2015 May 29;
Authors: Rokas KE, Johnson JW, Beardsley JR, Ohl CA, Luther VP, Williamson JC
BACKGROUND: The optimal therapy conducive to critically ill patients with Clostridium difficile pollution (CDI) is not known. We aimed to evaluate frequency of death among critically ill patients with CDI who believed oral vancomycin (monotherapy) versus oral vancomycin with intravenous (IV) metronidazole (combination therapy).
METHODS: A ~ out-center, retrospective, observational, comparative study was performed. Patients through a positive C. difficile assay who admitted oral vancomycin while bedded in some intensive care unit (ICU) between June 2007 and September 2012 were evaluated. Patients junction ≥3 of the following criteria were included: albumin <2.5g/dL, passion rate >90bpm, mean arterial constraining force <60mmHg, WBC ≥15,000 cells/mL, vale of years >60 years, serum creatinine ≥1.5 seasons baseline, or temperature ≥100.4°F. Patients in the coalition therapy group received IV metronidazole in the reach 48 hours after initiating vancomycin. Patients <18 years or through unrelated gastrointestinal disease were excluded. The aboriginal outcome was in-hospital mortality. Patients were matched using Acute Physiology and Chronic Health Evaluation II (APACHE II) scores.
RESULTS: Eighty-eight patients were included, 44 in each group. Patient characteristics were similar for all that more patients in the combination dispose had renal disease. Mortality was 36.4% and 15.9% in the monotherapy and association therapy groups, respectively (p=0.03). Secondary outcomes of clinical issue, length of stay, and length of ICU stay did not be at variance between groups.
CONCLUSIONS: Our data are supportive of the use of confederacy therapy with oral vancomycin and IV metronidazole in critically unfortunate patients with CDI. However, prospective, randomized studies are required to give the signification of optimal treatment regimens in this limited inhabitants of CDI patients.
PMID: 26024909 [PubMed – of the same kind with supplied by publisher]
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