title: A real-world evaluation of oral vancomycin for severe Clostridium difficile infection: implications for antibiotic stewardship programs.
abstract: OBJECTIVE
  To assess antibiotic treatment patterns and clinical outcomes of patients with Clostridium difficile infection (CDI) based on underlying severity of CDI disease.
  
  
  METHODS
  Retrospective analysis of data from a prospective cohort study.
  
  
  METHODS
  Large tertiary care university hospital.
  
  
  METHODS
  One hundred forty-four patients (mean ± SD age 63 ± 17 yrs) with CDI who received metronidazole (intravenous or oral) or oral vancomycin as their initial therapy option between 2006 and 2008.
  
  
  RESULTS
  Patients were stratified by severity of illness and treatment, and outcomes assessed were clinical response, relapse of disease, all-cause inpatient mortality, and length of hospital stay. Mild-moderate CDI disease was present in 85 patients (59%) and severe disease in 59 patients (41%). Overall, oral vancomycin was given to 16 patients (11%); use of this drug did not differ according to severity of infection. Among patients with severe disease, clinical success occurred in 32 (63%) of 51 patients given metronidazole and in all 8 patients (100%) given vancomycin (p=0.04). Inpatient mortality and hospital length of stay were lower in patients with severe CDI who were given oral vancomycin, although these results were not statistically significant.
  
  
  CONCLUSIONS
  Oral vancomycin was not commonly used for severe CDI. An improved clinical response rate was observed in patients with severe CDI given oral vancomycin; this outcome supported results from clinical trials. Antibiotic stewardship teams could play a major role in providing guidance on CDI treatment based on severity.
authors.affiliation: St. Luke's Episcopal Hospital, Houston, Texas, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: Le
authors.forename: Vaneet
authors.initials: V
authors.lastname: Arora
authors.forename: Dhara N
authors.initials: DN
authors.lastname: Shah
authors.forename: Miguel
authors.initials: M
authors.lastname: Salazar
authors.forename: Hannah R
authors.initials: HR
authors.lastname: Palmer
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Garey
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016360:Clostridioides difficile; D004341:Drug Evaluation; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014640:Vancomycin / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin