Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
J Am Geriatr Soc. 2013 Feb;61(2):222-30. doi: 10.1111/jgs.12090. Epub 2013 Feb 4.
To determine the effect of advancing age on the clinical outcomes of Clostridium difficile (CDI) treatment.
Regression modeling of results from two double-blind randomized multicenter studies on the treatment of primary and first recurrent cases of CDI to examine for effects of age and study drug on outcomes of cure (resolution of diarrhea), recurrence within 4 weeks of completing successful therapy, and cure without recurrence.
Participants were randomized into studies in the United States, Canada, and Europe.
Nine hundred ninety-nine individuals with toxin-positive CDI were randomized to receive vancomycin (125 mg 4 times daily) or fidaxomicin (200 mg twice daily) for 10 days.
The effect of advancing age in those aged 18 to 40 years and in 10-year increments thereafter was examined.
The model predicts a 17% lower clinical cure, 17% greater recurrence, and 13% lower sustained clinical response by advancing decade than in those younger than 40 (P < .01 each). Clinical cure was similar in the fidaxomicin and vancomycin treatment groups, although fidaxomicin was associated with a more than 50% lower relative risk for recurrence than vancomycin (P < .001). Multivariate regression modeling showed that risk factors accounting for poorer outcomes with advancing age include infection with the BI strain type, inpatient status, renal insufficiency, leukocytosis, hypoalbuminemia, and concomitant medication exposure.
Measurable and progressive deterioration in CDI treatment outcomes occurred with advancing age in those aged 40 and older, highlighting the need for prevention and treatment strategies. Fidaxomicin treatment was associated with a 60% lower risk of recurrence than vancomycin after adjusting for age, concomitant antibiotics, and C. difficile strain.
确定年龄增长对艰难梭菌（CDI）治疗临床结局的影响。
对两项双盲随机多中心研究结果进行回归建模，以研究年龄和研究药物对治愈（腹泻缓解）、完成成功治疗后 4 周内复发以及无复发治愈的影响。
参与者被随机分配到美国、加拿大和欧洲的研究中。
999 例毒素阳性 CDI 患者被随机分为万古霉素（125mg，每日 4 次）或菲达霉素（200mg，每日 2 次）治疗 10 天。
检查年龄在 18 至 40 岁之间和此后每 10 年递增的影响。
该模型预测，与 40 岁以下患者相比，每增加 10 岁，临床治愈率降低 17%，复发率增加 17%，持续临床应答率降低 13%（均 P <.01）。在菲达霉素和万古霉素治疗组中，临床治愈率相似，尽管菲达霉素与万古霉素相比，复发的相对风险降低了 50%以上（P <.001）。多变量回归模型显示，与年龄增长相关的预后较差的危险因素包括感染 BI 株型、住院状态、肾功能不全、白细胞增多、低白蛋白血症和同时使用药物。
在 40 岁及以上的患者中，随着年龄的增长，CDI 治疗结局出现了可衡量且逐渐恶化的情况，这突显了预防和治疗策略的必要性。在调整年龄、同时使用抗生素和艰难梭菌菌株后，菲达霉素治疗与万古霉素相比，复发风险降低了 60%。
