Umemura Takumi, Ota Aiko, Mutoh Yoshikazu, Norizuki Chihiro, Mizuno Takahito, Kozaki Koji, Ikeda Yoshiaki, Ichihara Toshihiko
1Department of Pharmacy, Tosei General Hospital, 160, Nishi oiwakecho, Seto, Aichi 489-8642 Japan.
2Department of Infection and Prevention, Tosei General Hospital, 160, Nishi oiwakecho, Seto, Aichi 489-8642 Japan.
J Pharm Health Care Sci. 2019 Aug 8;5:19. doi: 10.1186/s40780-019-0147-1. eCollection 2019.
According to the Clinical Practice Guidelines for , oral vancomycin is to be used in vancomycin tapered and pulsed regimen (VCM-TP) for recurrent infection (CDI). However, data on the efficacy of VCM-TP in Japanese patients with recurrent CDI are scarce. To address this gap, we investigated the efficacy of VCM-TP and performed a case-controlled study to assess the risk factors associated with treatment failure in these patients.
We conducted this study on all patients who were administered VCM-TP for recurrent episodes of CDI between January 2008 and December 2018 at Tosei General Hospital. All patients had documented follow-ups within 90 days after completion of the VCM-TP. Data were obtained for comparative analysis of treatment success or failure. Thirty-six patients were eligible for this study, and treatment success was documented in 23 patients (63.9%) following VCM-TP treatment. Treatment success was documented in 22 of 30 (73.3%) patients who received the recommended therapy according to the Clinical Practice Guidelines. The frequency of patients treated with the recommended therapy was higher in the treatment success group (95.7%) than in the treatment failure group (61.5%) (OR: 13.75, 95% CI: 1.39-136.39, = 0.016). Vancomycin-resistant enterococci culture tests were performed in 20 patients (55.6%), and all results were negative.
Our findings suggest that VCM-TP is a good therapeutic option for recurrent CDI in Japanese patients. Furthermore, administration of the recommended VCM-TP is important for achieving a high rate of treatment success. Hence, antimicrobial stewardship teams should support the implementation of recommended VCM-TPs.
根据《[具体指南名称]临床实践指南》，口服万古霉素用于复发性艰难梭菌感染（CDI）的万古霉素递减脉冲疗法（VCM - TP）。然而，关于VCM - TP对日本复发性CDI患者疗效的数据稀缺。为填补这一空白，我们调查了VCM - TP的疗效，并进行了一项病例对照研究，以评估这些患者治疗失败的相关危险因素。
我们对2008年1月至2018年12月期间在东生综合医院接受VCM - TP治疗复发性CDI的所有患者进行了这项研究。所有患者在VCM - TP完成后90天内均有记录的随访。获取数据以比较分析治疗成功或失败情况。36例患者符合本研究条件，VCM - TP治疗后23例患者（63.9%）记录为治疗成功。根据临床实践指南接受推荐治疗的30例患者中有22例（73.3%）记录为治疗成功。治疗成功组接受推荐治疗的患者频率（95.7%）高于治疗失败组（61.5%）（OR：13.75，95%CI：1.39 - 136.39，P = 0.016）。对其中20例患者（55.6%）进行了耐万古霉素肠球菌培养检测，所有结果均为阴性。
我们的研究结果表明，VCM - TP是日本复发性CDI患者的一种良好治疗选择。此外，给予推荐的VCM - TP对于实现高治疗成功率很重要。因此，抗菌药物管理团队应支持推荐的VCM - TP的实施。
