title: Age-Stratified Treatment Response Rates in Hospitalized Patients with Clostridium difficile Infection Treated with Metronidazole.
abstract: Consensus on the optimal treatment of Clostridium difficile infection (CDI) is rapidly changing. Treatment with metronidazole has been associated with increased clinical failure rates; however, the reasons for this are unclear. The purpose of this study was to assess age-related treatment response rates in hospitalized patients with CDI treated with metronidazole. This was a retrospective, multicenter cohort study of hospitalized patients with CDI. Patients were assessed for refractory CDI, defined as persistent diarrhea after 7 days of metronidazole therapy, and stratified by age and clinical characteristics. A total of 242 individuals, aged 60 ± 18 years (Charlson comorbidity index, 3.8 ± 2.4; Horn's index, 1.7 ± 1.0) were included. One hundred twenty-eight patients (53%) had severe CDI. Seventy patients (29%) had refractory CDI, a percentage that increased from 22% to 28% and to 37% for patients aged less than 50 years, for patients from 50 to 70 years, and for patients aged >70 years, respectively (P = 0.05). In multivariate analysis, Horn's index (odds ratio [OR], 2.04; 95% confidence interval [CI], 1.50 to 2.77; P < 0.001), severe CDI (OR, 2.25; 95% CI, 1.15 to 4.41; P = 0.018), and continued use of antibiotics (OR, 2.65; 95% CI, 1.30 to 5.39; P = 0.0072) were identified as significant predictors of refractory CDI. Age was not identified as an independent risk factor for refractory CDI. Therefore, hospitalized elderly patients with CDI treated with metronidazole had increased refractory CDI rates likely due to increased underlying severity of illness, severity of CDI, and concomitant antibiotic use. These results may help identify patients that may benefit from alternative C. difficile treatments other than metronidazole.
authors.affiliation: Department of Pharmacy, Memorial Hermann Northwest Hospital, Houston, Texas, USA.
authors.forename: Vy P
authors.initials: VP
authors.lastname: Pham
authors.affiliation: Department of Pharmacy Practice, Texas A&M Irma Lerma Rangel College of Pharmacy, Kingsville, Texas, USA.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Luce
authors.affiliation: Department of Research and Sponsored Programs, Harris Health System, Houston, Texas, USA.
authors.forename: Sara C
authors.initials: SC
authors.lastname: Ruppelt
authors.affiliation: Department of Pharmacy, Parkland Health and Hospital System, Dallas, Texas, USA.
authors.forename: Wenjing
authors.initials: W
authors.lastname: Wei
authors.affiliation: Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Samuel L
authors.initials: SL
authors.lastname: Aitken
authors.affiliation: Department of Pharmacy, Houston Methodist Hospital, Houston, Texas, USA.
authors.forename: William L
authors.initials: WL
authors.lastname: Musick
authors.affiliation: Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Ryan K
authors.initials: RK
authors.lastname: Roux
authors.affiliation: Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas, USA kgarey@uh.edu.
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Garey
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D016360:Clostridioides difficile / Q000187:drug effects* / Q000472:pathogenicity; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000494:pharmacology* / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole