Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Gut Liver. 2010 Sep;4(3):332-7. doi: 10.5009/gnl.2010.4.3.332. Epub 2010 Sep 24.
BACKGROUND/AIMS: 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.
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).
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.
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.
背景/目的：甲硝唑治疗后艰难梭菌相关性腹泻（CDAD）的治疗失败或复发的发生率最近有所增加。我们研究了甲硝唑治疗 CDAD 后的治疗失败、复发率和预测治疗失败和复发的危险因素。
我们回顾性地确定了韩国一家三级医疗机构在过去 10 年（即 1998-2008 年）中连续收治并治疗 CDAD 的患者。
甲硝唑被用作 117 例 CDAD 患者（94.9%）的初始治疗药物。14 例患者（12.6%）对甲硝唑治疗无临床反应，13 例患者（13.4%）在成功甲硝唑治疗后 CDAD 复发。糖尿病（p=0.014）和败血症（p=0.002）是甲硝唑治疗失败的独立危险因素。在 CDAD 发病前 1 个月内接受过手术的患者在甲硝唑治疗后更有可能复发（p=0.032）。甲硝唑治疗失败后，万古霉素的反应率更高，而甲硝唑在治疗复发方面表现出合理的反应率。在 10 年的研究期间，甲硝唑治疗 CDAD 后，随着时间的推移，治疗失败和复发的发生率增加。
我们的数据表明，糖尿病和败血症是甲硝唑治疗失败的独立危险因素，CDAD 发病前 1 个月内的手术史是甲硝唑治疗后复发的预测因素。
