title: Risk Factors for Treatment Failure and Recurrence after Metronidazole Treatment for Clostridium difficile-associated Diarrhea.
abstract: OBJECTIVE
  The incidence of treatment failure or recurrence of Clostridium difficile-associated diarrhea (CDAD) following metronidazole treatment has increased recently. We studied the treatment failure, recurrence rate, and risk factors predictive of treatment failure and recurrence after metronidazole treatment for CDAD.
  
  
  METHODS
  We retrospectively identified consecutive patients who were admitted and treated for CDAD at a single tertiary institution in Korea over a recent 10-year period (i.e., 1998-2008).
  
  
  RESULTS
  Metronidazole was administered as the initial treatment to 111 of 117 patients (94.9%) with CDAD. Fourteen patients (12.6%) had no clinical response to the metronidazole treatment, and in 13 patients (13.4%) CDAD recurred after successful metronidazole treatment. Diabetes mellitus (p=0.014) and sepsis (p=0.002) were independent risk factors for metronidazole treatment failure. Patients who had received surgery within 1 month before CDAD developed were more likely to experience a recurrence after metronidazole treatment (p=0.032). Vancomycin exhibited a higher response rate after treatment failure, and metronidazole showed a reasonable response rate in the treatment of recurrence. Treatment failure and recurrence rates increased with time after metronidazole treatment for CDAD over the 10-year study period.
  
  
  CONCLUSIONS
  Our data suggest that diabetes mellitus and sepsis are independent risk factors for metronidazole treatment failure, and that operation history within 1 month of development of CDAD is a predictor of a recurrence after metronidazole treatment.
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Kyu Sik
authors.initials: KS
authors.lastname: Jung
authors.forename: Jae Jun
authors.initials: JJ
authors.lastname: Park
authors.forename: Young Eun
authors.initials: YE
authors.lastname: Chon
authors.forename: Eun Suk
authors.initials: ES
authors.lastname: Jung
authors.forename: Hyun Jung
authors.initials: HJ
authors.lastname: Lee
authors.forename: Hui Won
authors.initials: HW
authors.lastname: Jang
authors.forename: Kyong Joo
authors.initials: KJ
authors.lastname: Lee
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Lee
authors.forename: Chang Mo
authors.initials: CM
authors.lastname: Moon
authors.forename: Jin Ha
authors.initials: JH
authors.lastname: Lee
authors.forename: Jae Kook
authors.initials: JK
authors.lastname: Shin
authors.forename: Soung Min
authors.initials: SM
authors.lastname: Jeon
authors.forename: Sung Pil
authors.initials: SP
authors.lastname: Hong
authors.forename: Tae Il
authors.initials: TI
authors.lastname: Kim
authors.forename: Won Ho
authors.initials: WH
authors.lastname: Kim
authors.forename: Jae Hee
authors.initials: JH
authors.lastname: Cheon