Summers Bryant B, Yates Mary, Cleveland Kerry O, Gelfand Michael S, Usery Justin
Henry Ford Hospital, Detroit, MI, USA.
Methodist Le Bonheur Germantown Hospital, Germantown, TN, USA.
Hosp Pharm. 2020 Aug;55(4):268-272. doi: 10.1177/0018578719844165. Epub 2019 Apr 23.
The most recent published guidelines on -associated diarrhea (CDAD) developed by the Infectious Diseases Society of America (IDSA) were released in 2017 and outline its treatment based on severity of the disease and recurrence; however, a clear first-line agent has not been recommended specifically for severe CDAD. This retrospective chart review was approved by the institutional review board and consisted of three community hospitals and one academic medical center. To be included, patients need to meet criteria for severe CDAD and receive at least 72 hours of therapy. Patients received either oral vancomycin or fidaxomicin, in addition to other therapies for CDAD, and differences in outcomes such as cost obtained from a common charge center, rates of recurrence, time to recurrence as measured at time of positive to negative polymerase chain reaction (PCR) test, and mortality were assessed. Of the 147 patients, 74 patients received fidaxomicin and 73 patients received oral vancomycin. The average hospitalization cost for patients receiving fidaxomicin was $129,338.69 and for patients receiving vancomycin was $153,563.81 ( = .26). Recurrence rates were lower with fidaxomicin compared with vancomycin (6.8% vs 17.6%; = .047), and time to recurrence was longer with fidaxomicin versus vancomycin, but not statistically significant (96.8 ± 45.9 days vs 63.2 ± 66.9 days; = .321). Mortality, length of stay in the intensive care unit, and overall length of stay were similar between the two therapies. In the treatment of severe CDAD, recurrence rates were lower and time to recurrence was higher with fidaxomicin compared with oral vancomycin. A clear financial benefit has yet to translate from these known findings.
美国传染病学会（IDSA）制定的关于艰难梭菌相关性腹泻（CDAD）的最新发布指南于2017年发布，该指南根据疾病的严重程度和复发情况概述了其治疗方法；然而，尚未专门推荐一种明确的一线药物用于严重CDAD。这项回顾性图表审查得到了机构审查委员会的批准，包括三家社区医院和一家学术医疗中心。要纳入研究，患者需要符合严重CDAD的标准并接受至少72小时的治疗。患者除接受CDAD的其他治疗外，还接受口服万古霉素或非达霉素治疗，并评估从共同收费中心获得的费用、复发率、从聚合酶链反应（PCR）检测呈阳性到阴性时测量的复发时间以及死亡率等结果差异。在147例患者中，74例患者接受非达霉素治疗，73例患者接受口服万古霉素治疗。接受非达霉素治疗的患者平均住院费用为129,338.69美元，接受万古霉素治疗的患者平均住院费用为153,563.81美元（P = 0.26）。与万古霉素相比，非达霉素的复发率更低（6.8%对17.6%；P = 0.047），非达霉素的复发时间比万古霉素更长，但无统计学意义（96.8±45.9天对63.2±66.9天；P = 0.321）。两种治疗方法的死亡率、重症监护病房住院时间和总住院时间相似。在严重CDAD的治疗中，与口服万古霉素相比，非达霉素的复发率更低，复发时间更长。这些已知发现尚未转化为明显的经济效益。
