National Institute for Infectious Diseases "Prof. Dr. Matei Bals", Bucharest, Romania; University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.
Unidad de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena / Universidad de Sevilla / Instituto de Biomedicina de Sevilla, Seville, Spain.
Clin Microbiol Infect. 2018 Feb;24(2):180-184. doi: 10.1016/j.cmi.2017.06.005. Epub 2017 Jun 19.
We aimed to compare the outcomes of patients with C.difficile infection (CDI) treated either with tigecycline associated with vancomycin, or with vancomycin alone.
This single-centre retrospective cohort study included all adults hospitalized from September 2014 through August 2015 for symptomatic, incident CDI confirmed by polymerase chain reaction for C. difficile toxin in stools. The primary outcome was the rate of favourable outcome, defined as a composite of clinical response (resolution of symptoms without need for additional CDI therapy) and achieving discharge without CDI-related surgery or intensive care; a secondary outcome was CDI recurrence. We constructed a non-parsimonious logistic regression model to calculate a propensity score (PS) for those receiving tigecycline.
In all, 266 patients were included: 62 patients received both vancomycin and tigecycline, and 204 patients received vancomycin alone. The patients from the two groups were similar regarding demographics and comorbidities but patients in the tigecycline group had a more severe CDI. A favourable outcome in the tigecycline group versus the vancomycin group was found in 50/62 (81%) versus 193/204 (95%). We matched patients receiving tigecycline or not according to the PS and 86 patients (43 pairs) could be matched. The OR for favourable outcome with tigecycline in the matched analysis was 0.92 (95% CI 0.60-1.44; p 0.74). The rate of CDI recurrences was 8/62 (13%) in the tigecycline group versus 39/204 (19%) in the vancomycin group (p 0.2).
Adding tigecycline to CDI standard therapy did not increase the clinical cure nor reduce the rate of CDI recurrences.
比较接受替加环素联合万古霉素与仅接受万古霉素治疗的艰难梭菌感染（CDI）患者的结局。
这是一项单中心回顾性队列研究，纳入 2014 年 9 月至 2015 年 8 月期间因粪便聚合酶链反应检测到艰难梭菌毒素阳性而确诊为症状性、新发 CDI 并住院的所有成年人。主要结局为临床结局良好的比例，定义为临床缓解（症状缓解，无需额外 CDI 治疗）和无 CDI 相关手术或重症监护的出院率之和；次要结局为 CDI 复发率。我们构建了一个非简约逻辑回归模型来计算接受替加环素治疗的患者的倾向评分（PS）。
共纳入 266 例患者：62 例患者同时接受万古霉素和替加环素治疗，204 例患者仅接受万古霉素治疗。两组患者在人口统计学和合并症方面相似，但替加环素组患者的 CDI 更为严重。与万古霉素组相比，替加环素组的临床结局良好的比例为 50/62（81%）和 193/204（95%）。我们根据 PS 匹配接受替加环素或未接受替加环素的患者，共匹配了 86 例（43 对）患者。在匹配分析中，替加环素治疗的良好结局的 OR 为 0.92（95%CI 0.60-1.44；p=0.74）。替加环素组的 CDI 复发率为 8/62（13%），万古霉素组为 39/204（19%）（p=0.2）。
在 CDI 标准治疗中添加替加环素并未增加临床治愈率，也未降低 CDI 复发率。
