Department of Pharmacy, Toho University Omori Medical Center, Japan.
Department of Infection Control and Prevention, Toho University Omori Medical Center, Japan.
Jpn J Infect Dis. 2024 Sep 19;77(5):281-284. doi: 10.7883/yoken.JJID.2023.483. Epub 2024 Mar 29.
Japanese guidelines recommend metronidazole (MNZ) and vancomycin (VCM) for non-severe and severe cases of Clostridioides difficile infection (CDI), respectively. In the present study, we investigated the use of CDI antimicrobials and evaluated their clinical efficacy and validity using four severity classifications. A retrospective chart review was conducted using the data of 137 inpatients with initially positive C. difficile toxin test results and the initiation of CDI antimicrobials between April 2015 and March 2019. Patients treated with VCM or oral MNZ were included for clinical efficacy analysis of CDI antimicrobials and validation of severity classifications. The endpoints were CDI recurrence, 30-day mortality, and diarrhea cure rates. No significant differences were found between the VCM and oral MNZ groups in the CDI recurrence rate (10.4% vs. 12.7%, P = 0.707), 30-day mortality rate (12.5% vs. 5.6%, P = 0.162), and diarrhea cure rate (61.9% vs. 72.7%, P = 0.238), regardless of severity. Treatment with oral MNZ for non-severe cases was promising, confirming its usefulness according to Japanese guidelines. Further investigation of the clinical efficacy of oral MNZ in patients with first-episode CDI and evaluation of the preferred severity classification are warranted.
日本指南分别推荐甲硝唑（MNZ）和万古霉素（VCM）用于非重症和重症艰难梭菌感染（CDI）病例。在本研究中，我们研究了 CDI 抗菌药物的使用，并使用四种严重程度分类评估了它们的临床疗效和有效性。对 2015 年 4 月至 2019 年 3 月期间最初阳性艰难梭菌毒素检测结果和开始使用 CDI 抗菌药物的 137 名住院患者的病历进行了回顾性图表审查。纳入接受 VCM 或口服 MNZ 治疗的患者进行 CDI 抗菌药物的临床疗效分析和严重程度分类验证。终点是 CDI 复发、30 天死亡率和腹泻治愈率。VCM 组和口服 MNZ 组在 CDI 复发率（10.4%比 12.7%，P = 0.707）、30 天死亡率（12.5%比 5.6%，P = 0.162）和腹泻治愈率（61.9%比 72.7%，P = 0.238）方面无显著差异，无论严重程度如何。根据日本指南，对于非重症病例使用口服 MNZ 治疗是有希望的，证实了其有用性。有必要进一步研究口服 MNZ 对首次发作 CDI 患者的临床疗效，并评估首选严重程度分类。
