Elbeddini Ali, Gerochi Rachel
Winchester District Memorial Hospital, 566 Louise Street, Winchester, ON, KK0C2K0, Canada.
Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, M5S 3M2, Canada.
J Pharm Policy Pract. 2021 Feb 11;14(1):19. doi: 10.1186/s40545-020-00289-1.
Clostridium difficile infection (CDI) is responsible for 15-25% cases of health-care-associated diarrhea. The CDI treatment algorithm used at our hospital is adapted from the Infectious Diseases Society of America 2010 C. difficile guideline. The primary objective of this study was to assess the treatment adherence to our algorithm; this was defined as therapy consisting of the appropriate antibiotic, dose, route, interval, and duration indicated based on the disease severity and episode within 24 h of diagnosis. Furthermore, our study also described the population and their risk factors for CDI at our hospital.
This was a single-centre, retrospective cohort chart review of CDI cases that were diagnosed at admission or during hospitalization from June 1st, 2017 to June 30th, 2018. Cases were identified by a positive stool test along with watery diarrhea or by colonoscopy.
Sixty cases were included, of which adherence to our algorithm was 50%. Overall, severe CDI had the highest treatment non-adherence (83%), and the biggest contributing factor was prescribing the wrong antibiotic (72%). In severe CDI, which warrants vancomycin monotherapy, wrong antibiotic consisted of metronidazole monotherapy (55%) or dual therapy with metronidazole and vancomycin (45%). Patients were mostly older, females being treated for an initial episode of mild-to-moderate CDI. Common risk factors identified were age over 65 years (80%), use of antibiotics (83%) and proton pump inhibitors (PPI) (68%) within the previous 3 months. The use of a PPI in this study, a modifiable risk factor without a clear indication, was 35%.
An area for antimicrobial stewardship intervention in CDI treatment at our hospital is prescribing the right antibiotic based on the CDI indication. In severe CDI, an emphasis should be on prescribing vancomycin monotherapy as the drug of choice. PPI use should be reassessed for tapering when appropriate.
艰难梭菌感染（CDI）导致15% - 25%的医疗保健相关腹泻病例。我院使用的CDI治疗方案改编自美国传染病学会2010年艰难梭菌指南。本研究的主要目的是评估对我院治疗方案的依从性；这被定义为在诊断后24小时内，根据疾病严重程度和发作情况，采用适当的抗生素、剂量、途径、间隔和疗程进行治疗。此外，我们的研究还描述了我院CDI患者群体及其危险因素。
这是一项单中心回顾性队列研究，对2017年6月1日至2018年6月30日期间入院或住院期间诊断为CDI的病例进行病历审查。通过粪便检测阳性伴水样腹泻或结肠镜检查来确定病例。
共纳入60例病例，其中对我院治疗方案的依从率为50%。总体而言，重度CDI的治疗不依从率最高（83%），最大的影响因素是开具错误的抗生素（72%）。在需要万古霉素单药治疗的重度CDI中，错误的抗生素包括甲硝唑单药治疗（55%）或甲硝唑与万古霉素联合治疗（45%）。患者大多年龄较大，女性多为首次发生的轻至中度CDI。确定的常见危险因素包括65岁以上（80%）、在过去3个月内使用抗生素（83%）和质子泵抑制剂（PPI）（68%）。本研究中，在无明确指征情况下使用PPI这一可改变的危险因素的比例为35%。
我院CDI治疗中抗菌药物管理干预的一个领域是根据CDI指征开具正确的抗生素。在重度CDI中，应强调将万古霉素单药治疗作为首选药物。应重新评估PPI的使用情况，以便在适当的时候逐渐减少用量。
