OBJECTIVE: Osteoarticular infections require several weeks of antibiotic therapy, but little is known about the epidemiology of adverse events (AE) including symptomatic Clostridium difficile-associated diarrhea during treatment in these patients. METHODS: Cohort study (1996-2011) at a tertiary hospital non-endemic for clostridial ribotype O27. Patients with previous C. difficile episodes and metronidazole treatment were excluded. RESULTS: A total of 393 episodes were identified. Median age of patients was 69 years; 122 were immune-suppressed. All patients received antibiotic treatment for a median of 8 weeks, including 2 weeks intravenously (range, 0-9 weeks). Oral rifampin (600 mg/d) was used in combination in 167 (42%) episodes. A relatively small number of episodes (115/393; 29%) were complicated by AE (diarrhea, nausea, cholestasis, gastric intolerance to rifampin, rash, and mycosis), of which 41 (36%) led to treatment modification. AE occurred mainly after a median of 21 days. Fourteen patients (14/393; 3.6%) developed symptomatic C. difficile diarrhea. By multivariate Cox regression analysis, total duration of antibiotic therapy, and intravenous administration were significantly associated with AE (all p < 0.01). Regarding symptomatic C. difficile infection, rifampin (hazard ratio 0.21; 95% CI, 0.05-0.97) protected from diarrhea, but not gender or age. Hospital stay was significantly longer among patients with AE than patients without (median 78 vs. 42 d; p < 0.01). CONCLUSIONS: AE were frequent and were observed in 29% of patients treated for osteoarticular infections and prolonged the hospital stay. In contrast, diarrhea due to C. difficile was rare, while oral rifampin might act protectively against it.
OBJECTIVE:Osteoarticular infections require several weeks of antibiotic therapy, but little is known about the epidemiology of adverse events (AE) including symptomatic Clostridium difficile-associated diarrhea during treatment in these patients. METHODS: Cohort study (1996-2011) at a tertiary hospital non-endemic for clostridial ribotype O27. Patients with previous C. difficile episodes and metronidazole treatment were excluded. RESULTS: A total of 393 episodes were identified. Median age of patients was 69 years; 122 were immune-suppressed. All patients received antibiotic treatment for a median of 8 weeks, including 2 weeks intravenously (range, 0-9 weeks). Oral rifampin (600 mg/d) was used in combination in 167 (42%) episodes. A relatively small number of episodes (115/393; 29%) were complicated by AE (diarrhea, nausea, cholestasis, gastric intolerance to rifampin, rash, and mycosis), of which 41 (36%) led to treatment modification. AE occurred mainly after a median of 21 days. Fourteen patients (14/393; 3.6%) developed symptomatic C. difficilediarrhea. By multivariate Cox regression analysis, total duration of antibiotic therapy, and intravenous administration were significantly associated with AE (all p < 0.01). Regarding symptomatic C. difficileinfection, rifampin (hazard ratio 0.21; 95% CI, 0.05-0.97) protected from diarrhea, but not gender or age. Hospital stay was significantly longer among patients with AE than patients without (median 78 vs. 42 d; p < 0.01). CONCLUSIONS: AE were frequent and were observed in 29% of patients treated for osteoarticular infections and prolonged the hospital stay. In contrast, diarrhea due to C. difficile was rare, while oral rifampin might act protectively against it.
Authors: V Prendki; T Ferry; P Sergent; E Oziol; E Forestier; T Fraisse; S Tounes; S Ansart; J Gaillat; S Bayle; O Ruyer; F Borlot; G Le Falher; B Simorre; F-A Dauchy; S Greffe; T Bauer; E N Bell; B Martha; M Martinot; M Froidure; M Buisson; A Waldner; X Lemaire; A Bosseray; M Maillet; V Charvet; A Barrelet; B Wyplosz; M Noaillon; E Denes; E Beretti; M Berlioz-Thibal; V Meyssonnier; E Fourniols; L Tliba; A Eden; M Jean; C Arvieux; K Guignery-Kadri; C Ronde-Oustau; Y Hansmann; A Belkacem; F Bouchand; G Gavazzi; F Herrmann; J Stirnemann; A Dinh Journal: Eur J Clin Microbiol Infect Dis Date: 2017-04-04 Impact factor: 3.267
Authors: Jacqueline Färber; Sebastian Illiger; Fabian Berger; Barbara Gärtner; Lutz von Müller; Christoph H Lohmann; Katja Bauer; Christina Grabau; Stefanie Zibolka; Dirk Schlüter; Gernot Geginat Journal: Antimicrob Resist Infect Control Date: 2017-02-15 Impact factor: 4.887
Authors: Elizabeth H Skinner; Melanie Lloyd; Edward Janus; May Lea Ong; Amalia Karahalios; Terry P Haines; Anne-Maree Kelly; Melina Shackell; Harin Karunajeewa Journal: Trials Date: 2018-02-05 Impact factor: 2.279