Drozdinsky Genady, Vronsky Daniella, Atamna Alaa, Ben-Zvi Haim, Bishara Jihad, Eliakim-Raz Noa
Internal Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Intern Emerg Med. 2025 Jan;20(1):189-195. doi: 10.1007/s11739-024-03779-1. Epub 2024 Oct 5.
Clostridioides difficile (CDI) is a common cause of infectious diarrhea. The current recommendation is to initiate empirical antibiotic treatment for suspected CDI who have an anticipated delay of confirmatory results or fulminant colitis. This is based on limited clinical trials. The study aims to examine the impact of early treatment on mortality and clinical outcomes.
This retrospective cohort study included adult patients with CDI. Early treatment was defined as the initiation of an anti-Clostridioides medication within the first 24 h following stool sampling. Outcomes were 30 and 90 day mortality, length of hospital stay (LOS), recurrence, and colectomy rate. To address potential bias, propensity score matching followed by logistic regression was performed, P value less than 5% was considered statistically significant.
Study cohort consisted of 796 patients; clinical characteristics were balanced following matching. There was no difference, in favor of early treatment, between the groups regarding 30 day mortality and 90 day mortality with HR of 0.91 (95% CI 0.56-1.47) and 0.7 (95% CI 0.45-1.08), respectively. No statistically significant difference in recurrence rate, ICU admission or colectomy rate was observed. The LOS was shorter in the early-treatment group with 6 days vs. 8 days.
Early treatment for CDI had shortened hospital stay. However, it did not affect clinical outcomes in adult patients.
艰难梭菌（CDI）是感染性腹泻的常见病因。目前的建议是，对于预期确认结果会延迟或患有暴发性结肠炎的疑似CDI患者，应开始经验性抗生素治疗。这是基于有限的临床试验得出的结论。本研究旨在探讨早期治疗对死亡率和临床结局的影响。
这项回顾性队列研究纳入了成年CDI患者。早期治疗定义为在粪便采样后的前24小时内开始使用抗艰难梭菌药物。观察指标包括30天和90天死亡率、住院时间（LOS）、复发率和结肠切除术率。为解决潜在偏倚问题，先进行倾向评分匹配，然后进行逻辑回归分析，P值小于5%被认为具有统计学意义。
研究队列包括796例患者；匹配后临床特征达到平衡。两组在30天死亡率和90天死亡率方面没有差异，早期治疗组不占优势，风险比分别为0.91（95%可信区间0.56 - 1.47）和0.7（95%可信区间0.45 - 1.08）。在复发率、入住重症监护病房或结肠切除术率方面未观察到统计学显著差异。早期治疗组的住院时间较短，为6天，而另一组为8天。
CDI的早期治疗缩短了住院时间。然而，它并未影响成年患者的临床结局。
