title: Lack of association of outcomes with treatment duration and microbiologic susceptibility data in Clostridium difficile infections in a non-NAP1/BI/027 setting.
abstract: BACKGROUND
  Concerns regarding the poor response of severe Clostridium difficile infection (CDI) treated with metronidazole have arisen over the last 5 y.
  
  
  METHODS
  We conducted a prospective, non-interventional study of CDI cases at our institution to evaluate the role of drug resistance, co-morbidities, and the emergence of hypervirulent strains on patient outcomes. A total of 118 adult inpatients with diarrhea and a positive stool for C. difficile toxin immunoassay had positive stool cultures and were included in the study. All 118 isolates had vancomycin and metronidazole susceptibility testing via the E-test method; rep-PCR was performed on 47 isolates. Of the 118 study patients, 107 were treated with either metronidazole or vancomycin.
  
  
  RESULTS
  Initial therapy was metronidazole in 98.1% (n = 105) and vancomycin in 1.9% (n = 2) patients. Evaluable clinical response within 5 days of treatment was noted in 52.5% (52/99) of cases. The mean duration of treatment was 11.7 ± 7.2 days. The 30-day all-cause mortality rate was 24.6% (29/118). Recurrence occurred in 23.6% (21/89). A recent stay in the intensive care unit was associated with increased 30-day mortality (odds ratio 3.58, p = 0.012). There were no isolates resistant to metronidazole or vancomycin. Only 1 isolate was possibly related to the NAP1/BI/027 reference strain. No strain-related differences in deaths or recurrence were noted.
  
  
  CONCLUSIONS
  Deaths related to CDI in our study appear to be related to multiple factors and did not appear to be independently related to antibiotic susceptibility, strain type, or treatment duration.
authors.affiliation: Division of Infectious Diseases and Department of Medicine, St John Hospital and Medical Center, MI 48236, USA. anilrudh.venugopal@stjohn.org
authors.forename: Anilrudh A
authors.initials: AA
authors.lastname: Venugopal
authors.forename: Kathleen
authors.initials: K
authors.lastname: Riederer
authors.forename: Shilpa M
authors.initials: SM
authors.lastname: Patel
authors.forename: Susanna
authors.initials: S
authors.lastname: Szpunar
authors.forename: Houssein
authors.initials: H
authors.lastname: Jahamy
authors.forename: Sharon
authors.initials: S
authors.lastname: Valenti
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Shemes
authors.forename: Riad
authors.initials: R
authors.lastname: Khatib
authors.forename: Leonard B
authors.initials: LB
authors.lastname: Johnson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D016360:Clostridioides difficile / Q000187:drug effects* / Q000302:isolation & purification; D003967:Diarrhea / Q000188:drug therapy / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy* / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000494:pharmacology / Q000627:therapeutic use; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome; D014640:Vancomycin / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D014640:Vancomycin