Fisher Aaron, Khanal Pradeep, Gniado Ewa, Khaddour Leila, Orosey Molly, Hader Ismail, Yadav Siddhartha, Halalau Alexandra
Beaumont Health, Royal Oak, MI, USA.
Bronson Methodist Hospital, Kalamazoo, MI, USA.
Gastroenterol Res Pract. 2018 May 27;2018:7192728. doi: 10.1155/2018/7192728. eCollection 2018.
infection (CDI) is the leading cause of hospital-associated gastrointestinal illness. Previous studies reported that patients with active malignancy are at high risk for CDIs, and yet they are still classified as nonsevere CDI and initially treated with metronidazole. Our aim is to investigate the need for the escalation of antibiotic therapy in patients with CDI and active cancer treated with oral metronidazole versus oral vancomycin.
This is a retrospective study of adult patients admitted with CDI and any underlying active malignancy at Beaumont Hospital, Royal Oak, Michigan, from January 2008 to December 2014. Inclusion criteria included age > 18 years old, polymerase chain reaction- (PCR-) proven CDI, and active malignancy.
197 patients were included in the final analysis. 44.8% of the metronidazole group required escalation of therapy compared to 15.2% in the vancomycin group ( value = 0.001). 29.8% of the combination group (metronidazole and vancomycin) underwent deescalation of antibiotics, which was significantly higher compared to 2.2% of patients in the vancomycin group ( value < 0.001).
Our results support the initial use of vancomycin or a combination (metronidazole and vancomycin) versus metronidazole in patients with CDI and active malignancy.
艰难梭菌感染（CDI）是医院获得性胃肠道疾病的主要原因。既往研究报道，患有活动性恶性肿瘤的患者发生CDI的风险很高，但他们仍被归类为非重度CDI，最初接受甲硝唑治疗。我们的目的是研究对于接受口服甲硝唑与口服万古霉素治疗的CDI合并活动性癌症患者，是否需要加强抗生素治疗。
这是一项对2008年1月至2014年12月在密歇根州皇家橡树市博蒙特医院因CDI及任何潜在活动性恶性肿瘤入院的成年患者进行的回顾性研究。纳入标准包括年龄>18岁、聚合酶链反应（PCR）证实的CDI以及活动性恶性肿瘤。
197例患者纳入最终分析。甲硝唑组44.8%的患者需要加强治疗，而万古霉素组为15.2%（P值=0.001）。联合治疗组（甲硝唑和万古霉素）29.8%的患者抗生素治疗降级，这显著高于万古霉素组2.2%的患者（P值<0.001）。
我们的结果支持对于CDI合并活动性恶性肿瘤的患者，初始使用万古霉素或联合用药（甲硝唑和万古霉素）而非甲硝唑。
