Shani Zilberman-Itskovich1, Ilan Youngster2,3, Tsilia Lazarovitch4, Marina Bondarenco1, Limor Toledano2,5, Yael Kachlon2,5, Bethlehem Mengesha1, Nathan Strul6, Ronit Zaidenstein1,5, Dror Marchaim5,6. 1. Internal Medicine A, Assaf Harofeh Medical Center, Zerifin, Israel. 2. Pediatric Division, Assaf Harofeh Medical Center, Zerifin, Israel. 3. Center for Microbiome Research, Assaf Harofeh Medical Center, Zerifin, Israel. 4. Microbiology Laboratory, Assaf Harofeh Medical Center, Zerifin, Israel. 5. Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. 6. Unit of Infection Control, Assaf Harofeh Medical Center, Zerifin, Israel.
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.
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.
Authors: Margherita Gnocchi; Martina Gagliardi; Pierpacifico Gismondi; Federica Gaiani; Gian Luigi De' Angelis; Susanna Esposito Journal: Pathogens Date: 2020-04-16