Early treatment for Clostridioides difficile infection: retrospective cohort study.

IF 3.2 3区医学 Q1 MEDICINE, GENERAL & INTERNAL Internal and Emergency Medicine Pub Date : 2025-01-01 Epub Date: 2024-10-05 DOI:10.1007/s11739-024-03779-1

Genady Drozdinsky, Daniella Vronsky, Alaa Atamna, Haim Ben-Zvi, Jihad Bishara, Noa Eliakim-Raz

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Abstract

Introduction: 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.

Methods: 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.

Results: 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.

Conclusion: Early treatment for CDI had shortened hospital stay. However, it did not affect clinical outcomes in adult patients.

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艰难梭菌感染的早期治疗：回顾性队列研究。

导言：艰难梭菌（CDI）是感染性腹泻的常见病因。目前的建议是，对于疑似 CDI 患者，如果预计确诊结果会延迟或出现暴发性结肠炎，则应启动经验性抗生素治疗。这一建议是基于有限的临床试验提出的。本研究旨在探讨早期治疗对死亡率和临床结果的影响：这项回顾性队列研究包括 CDI 成年患者。早期治疗的定义是在粪便采样后的 24 小时内开始服用抗梭状芽孢杆菌药物。研究结果包括 30 天和 90 天死亡率、住院时间（LOS）、复发率和结肠切除率。为解决潜在的偏倚问题，研究人员进行了倾向评分匹配，然后进行了逻辑回归，P 值小于 5%即为具有统计学意义：研究队列由 796 名患者组成；匹配后临床特征保持平衡。两组患者的 30 天死亡率和 90 天死亡率没有差异（HR 分别为 0.91（95% CI 0.56-1.47）和 0.7（95% CI 0.45-1.08）），均有利于早期治疗。在复发率、入住重症监护室率或结肠切除率方面，未观察到有统计学意义的差异。早期治疗组患者的住院时间较短，分别为 6 天和 8 天：结论：早期治疗 CDI 可缩短住院时间。结论：早期治疗 CDI 可缩短住院时间，但不会影响成人患者的临床疗效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Internal and Emergency Medicine 医学-医学：内科

CiteScore

7.20

自引率

4.30%

发文量

258

审稿时长

6-12 weeks

期刊介绍： Internal and Emergency Medicine (IEM) is an independent, international, English-language, peer-reviewed journal designed for internists and emergency physicians. IEM publishes a variety of manuscript types including Original investigations, Review articles, Letters to the Editor, Editorials and Commentaries. Occasionally IEM accepts unsolicited Reviews, Commentaries or Editorials. The journal is divided into three sections, i.e., Internal Medicine, Emergency Medicine and Clinical Evidence and Health Technology Assessment, with three separate editorial boards. In the Internal Medicine section, invited Case records and Physical examinations, devoted to underlining the role of a clinical approach in selected clinical cases, are also published. The Emergency Medicine section will include a Morbidity and Mortality Report and an Airway Forum concerning the management of difficult airway problems. As far as Critical Care is becoming an integral part of Emergency Medicine, a new sub-section will report the literature that concerns the interface not only for the care of the critical patient in the Emergency Department, but also in the Intensive Care Unit. Finally, in the Clinical Evidence and Health Technology Assessment section brief discussions of topics of evidence-based medicine (Cochrane’s corner) and Research updates are published. IEM encourages letters of rebuttal and criticism of published articles. Topics of interest include all subjects that relate to the science and practice of Internal and Emergency Medicine.