Potential impact of removing metronidazole from treatment armamentarium of mild acute Clostridioides difficile infection

Shani Zilberman-Itskovich, Ilan Youngster, Tsilia Lazarovitch, Marina Bondarenco, Limor Toledano, Yael Kachlon, Bethlehem Mengesha, Nathan Strul, Ronit Zaidenstein, Dror Marchaim*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Aim: Recent guidelines recommended removing metronidazole as a therapeutic option for Clostridioides difficile infections (CDI). However, superiority of vancomycin over metronidazole in mild CDI is not established and use of vancomycin might lead to emergence of vancomycin-resistant enterococci (VRE). Patients & methods: A retrospective cohort study and efficacy analyses were conducted at Shamir Medical Center, Israel (2010-2015), among adults with acute CDI. Results: A total of 409 patients were enrolled. In multivariable analyses, metronidazole was noninferior to vancomycin for mild CDI, but vancomycin was an independent predictor for post-CDI VRE acquisition. Conclusion: A significant independent association was evident between treatment with vancomycin and, later, acquisition of VRE. In first episodes of mild acute CDI, metronidazole should be considered a valid therapeutic option.

Original languageEnglish
Pages (from-to)1489-1495
Number of pages7
JournalFuture Microbiology
Volume14
Issue number17
DOIs
StatePublished - 2019

Keywords

  • CDI
  • Clostridium difficile
  • IDSA guidelines
  • antimicrobial stewardship
  • diarrhea
  • efficacy analysis
  • infectious diseases
  • metronidazole
  • nosocomial infections
  • vancomycin

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