Département de Médecine Générale, l'Université de Versailles Saint Quentin en Yvelines, France.
Pharmacie Hospitalière, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France.
Eur J Gen Pract. 2021 Dec;27(1):320-325. doi: 10.1080/13814788.2021.1998447.
infection (CDI) is rising and increases patient healthcare costs due to extended hospitalisation, tests and medications. Management of CDI in French primary care is poorly reported.
To characterise patients suffering from CDI, managed in primary care and describe their clinical outcomes.
Retrospective observational study based on survey data among 500 randomly selected General Practitioners (GPs) surveyed in France from September 2018 to April 2019. GPs were asked to complete a multiple-choice questionnaire for each reported patient presenting a CDI. Responses were analysed according to clinical characteristics. Treatment strategies were compared according to the outcome: recovery or recurrent infection.
Participation rate was 8.6% ( = 43/500) with two incomplete questionnaires. Data from 41 patients with an actual diagnosis of CDI were analysed. Recovery was observed in 61% of patients with a confirmed diagnosis of CDI. In the recovery group, this was exclusively a primary episode, most patients (72%) had no comorbidities, were significantly younger ( = 0.02) than the ones who relapsed and 92% were successfully treated with oral metronidazole. Duration of diarrhoea after antimicrobial treatment initiation was significantly shorter in the recovery group (≤ 48 h) ( = 0.03). Cooperation with hospital specialists was reported in 28% of the recovery group versus 87.5% of the recurrent group ( = 0.0003). Overall, GPs managed successfully 82.9% of cases without need of hospital admission.
GPs provide relevant ambulatory care for mild primary episodes of CDI using oral metronidazole. Persistent diarrhoea despite an appropriate anti-Clostridiodes regimen should be interpreted as an early predictor of relapse.
由于住院时间延长、检查和药物治疗，感染（CDI）不断增加，增加了患者的医疗保健成本。法国初级保健中 CDI 的管理报道甚少。
描述在初级保健中管理的 CDI 患者的特征，并描述其临床结局。
这是一项基于调查数据的回顾性观察研究，调查了 2018 年 9 月至 2019 年 4 月期间法国随机抽取的 500 名全科医生（GP）。要求每位报告的 CDI 患者填写一份多选择题问卷。根据临床特征对回答进行分析。根据结局（康复或复发感染）比较治疗策略。
参与率为 8.6%（ = 43/500），其中有 2 份问卷不完整。共分析了 41 名确诊 CDI 患者的数据。在确诊为 CDI 的患者中，61%的患者康复。在康复组中，这完全是首发感染，大多数患者（72%）没有合并症，显著比复发组年轻（ = 0.02），92%的患者成功接受了口服甲硝唑治疗。与起始抗菌治疗后腹泻持续时间相关，在康复组中明显更短（≤ 48 小时）（ = 0.03）。在康复组中，有 28%的患者与医院专家合作，而在复发组中，有 87.5%的患者与医院专家合作（ = 0.0003）。总体而言，82.9%的病例无需住院即可由全科医生成功管理。
GP 对轻度原发性 CDI 采用口服甲硝唑进行了合理的门诊治疗。尽管采用了适当的抗梭状芽孢杆菌方案，但持续腹泻应被视为复发的早期预测指标。
