Risk Factors for Treatment Failure and Recurrence after Metronidazole Treatment for Clostridium difficile-associated Diarrhea.
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.
Jung
Kyu Sik
KS
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Park
Jae Jun
JJ
Chon
Young Eun
YE
Jung
Eun Suk
ES
Lee
Hyun Jung
HJ
Jang
Hui Won
HW
Lee
Kyong Joo
KJ
Lee
Sang Hoon
SH
Moon
Chang Mo
CM
Lee
Jin Ha
JH
Shin
Jae Kook
JK
Jeon
Soung Min
SM
Hong
Sung Pil
SP
Kim
Tae Il
TI
Kim
Won Ho
WH
Cheon
Jae Hee
JH