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Abstract：
The European Society of Clinical Microbiology and Infectious Disease (ESCMID) has advised against the use of metronidazole for fulminant Clostridioides difficile (C. difficile) infection (CDI) in their latest guidelines. They suggest using oral vancomycin alone instead. This recommendation is based on a few retrospective studies, which have multiple biases. We evaluated the three studies that led ESCMID to advise against intravenous metronidazole for fulminant CDI and performed a meta-analysis. The meta-analysis revealed a mild (2.7%), not statistically significant (p=0.8) difference in mortality between the two groups. The high heterogeneity (I2= 89%) should also be noted. The decision to add or remove metronidazole should be discussed in the near future. In the meantime, combination therapy could be a cautious treatment for fulminant CDI.
摘要：
欧洲临床微生物学和传染病学会（ESCMID）建议不要将甲硝唑用于暴发性艰难梭菌（C.艰难）感染（CDI）在他们的最新指南中。他们建议单独使用口服万古霉素。这项建议是基于一些回顾性研究，有多重偏见。我们评估了导致ESCMID建议不要静脉注射甲硝唑治疗暴发性CDI的三项研究，并进行了荟萃分析。荟萃分析显示轻度(2.7%)，两组间死亡率差异无统计学意义(p=0.8).还应注意高异质性(I2=89%)。应该在不久的将来讨论添加或删除甲硝唑的决定。同时,联合治疗可能是暴发性CDI的谨慎治疗.
