Department of Infectious Diseases, Charles University, 3rd Faculty of Medicine and Na Bulovce Teaching Hospital, Prague, Czech Republic.
Department of Medical Microbiology, Charles University, 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic.
Int J Infect Dis. 2021 Feb;103:226-233. doi: 10.1016/j.ijid.2020.11.004. Epub 2020 Nov 11.
We aimed to evaluate the efficacy of different antibiotic regimens for the treatment of Clostridioides difficile infection (CDI) with regard to the CDI episode number and disease severity.
An observation cohort study included 271 CDI patients hospitalised between 2013-2016. Univariate logistic regression was used to evaluate the association between patients' clinical outcome (sustained clinical cure or recurrence) in a 60-day follow-up and the antibiotic regimen used (oral metronidazole, oral vancomycin, combination of oral vancomycin and metronidazole, oral fidaxomicin). Subgroup analyses, based on CDI episode number and severity, were performed.
In the overall population, fidaxomicin was superior to metronidazole, vancomycin or their combination, for a sustained clinical response and in the prevention of recurrent CDI (rCDI). In the subgroup analyses, fidaxomicin was superior to vancomycin or metronidazole for a sustained clinical response and in the prevention of rCDI in the initial episode, first recurrence and non-severe cases. In the oral treatment of severe CDI, fidaxomicin had a similar treatment outcome to vancomycin and none of the antibiotic treatments were superior in the prevention of rCDI. Fidaxomicin, vancomycin, or a combination of metronidazole and vancomycin, had similar outcomes for sustained clinical response and prevention of rCDI in patients with multiple rCDI.
Fidaxomicin was superior to metronidazole or vancomycin for the treatment of the initial episode, first recurrence, and non-severe CDI.
我们旨在评估不同抗生素方案治疗艰难梭菌感染（CDI）的疗效，重点关注 CDI 发作次数和疾病严重程度。
一项观察性队列研究纳入了 2013 年至 2016 年期间住院的 271 例 CDI 患者。采用单因素逻辑回归评估了 60 天随访时患者临床结局（持续临床治愈或复发）与所使用抗生素方案（口服甲硝唑、口服万古霉素、口服万古霉素联合甲硝唑、口服非达霉素）之间的关联。根据 CDI 发作次数和严重程度进行了亚组分析。
在总体人群中，非达霉素在持续临床应答和预防复发性 CDI（rCDI）方面优于甲硝唑、万古霉素或两者联合治疗。在亚组分析中，非达霉素在初始发作、首次复发和非严重病例中，在持续临床应答和预防 rCDI 方面优于万古霉素或甲硝唑。在严重 CDI 的口服治疗中，非达霉素与万古霉素的治疗结果相似，且在预防 rCDI 方面，没有任何一种抗生素治疗具有优势。在多次 rCDI 的患者中，非达霉素、万古霉素或甲硝唑联合万古霉素在持续临床应答和预防 rCDI 方面具有相似的效果。
非达霉素在治疗初始发作、首次复发和非严重 CDI 方面优于甲硝唑或万古霉素。
