目的:尽管在西方国家不推荐甲硝唑治疗艰难梭菌感染(CDI),在2020年台湾成年人中,仍建议将其用于非重度CDI的治疗.在一项前瞻性临床研究中,对甲硝唑治疗CDI的临床作用进行了研究。
方法:本研究于2015年1月至2016年12月在台湾三家医院进行。甲硝唑治疗失败(MTF)定义为治疗6天后持续腹泻,药物调整(转向口服万古霉素),或治疗五天后死亡。
结果:总体而言,包括325例接受甲硝唑治疗CDI的患者。总MTF率为48.6%(158例)。外周血白细胞计数>15,000个细胞/mL(奇数比[OR]1.81;P=0.04)和充血性心力衰竭(OR3.26;P=0.02)与MTF独立相关。白细胞计数≤15,000细胞/mL且无充血性心力衰竭患者的MTF率,白细胞计数>15,000细胞/mL,无充血性心力衰竭,白细胞计数≤15,000细胞/mL和充血性心力衰竭,白细胞计数>15,000细胞/mL,充血性心力衰竭占44.2%,51.8%,73.3%,和66.7%,分别。值得注意的是,经历过MTF的患者的CDI复发率高于甲硝唑治疗成功的患者(13.9%vs.6.0%,P=0.02)。
结论:对于患有CDI的台湾成年人,甲硝唑治疗的失败率接近50%,这表明重新评估甲硝唑治疗的治疗作用,尤其是白细胞增多或潜在的充血性心力衰竭患者。
OBJECTIVE: Although metronidazole is not recommended to treat Clostridioides difficile infection (CDI) in Western countries, it was still to be recommended for the treatment of non-severe CDI among Taiwanese adults in 2020. This controversy in the clinical role of metronidazole therapy for CDI was examined in a prospective clinical study.
METHODS: The study was conducted from January 2015 to December 2016 in three hospitals in Taiwan. Metronidazole treatment failure (MTF) was defined as the persistence of diarrhea after six days of treatment, medication modification (shifting to oral vancomycin), or death after five days of therapy.
RESULTS: Overall, 325 patients receiving metronidazole for CDI were included. The overall MTF rate was 48.6% (158 patients). Leukocyte counts of >15,000 cells/mL in peripheral blood (odd ratio [OR] 1.81; P = 0.04) and congestive heart failure (OR 3.26; P = 0.02) were independently associated with MTF. The MTF rate for patients with leukocyte counts of ≤15,000 cells/mL and no congestive heart failure, leukocyte counts of >15,000 cells/mL and no congestive heart failure, leukocyte counts of ≤15,000 cells/mL and congestive heart failure, and leukocyte counts of >15,000 cells/mL and congestive heart failure were 44.2%, 51.8%, 73.3%, and 66.7%, respectively. Of note, patients who experienced MTF had a higher recurrence rate of CDI than those with metronidazole treatment success (13.9% vs. 6.0%, P = 0.02).
CONCLUSIONS: For Taiwanese adults with CDI, the failure rate of metronidazole therapy approached 50%, which suggests the reappraisal of the therapeutic role of metronidazole therapy, especially for patients with leukocytosis or underlying congestive heart failure.