The Addition of Intravenous Metronidazole to Oral Vancomycin is Associated With Improved Mortality in Critically Ill Patients With Clostridium difficile Infection

摘要

We evaluated critically ill patients with Clostridium difficile infection who received oral vancomycin with or without intravenous metronidazole. Mortality was lower among patients who received combination therapy.Methods.aEuro integral A single-center, retrospective, observational, comparative study was performed. Patients with a positive C. difficile assay who received oral vancomycin while bedded in an intensive care unit (ICU) between June 2007 and September 2012 were evaluated. Patients meeting a parts per thousand yen3 of the following criteria were included: albumin < 2.5 g/dL, heart rate > 90 bpm, mean arterial pressure < 60 mmHg, white blood cell count a parts per thousand yen15 000 cells/mL, age > 60 years, serum creatinine a parts per thousand yen1.5 times baseline, or temperature a parts per thousand yen100.4A degrees F. Patients in the combination therapy group received IV metronidazole within 48 hours after initiating vancomycin. Patients < 18 years or with unrelated gastrointestinal disease were excluded. The primary outcome was in-hospital mortality. Patients were matched using Acute Physiology and Chronic Health Evaluation II scores.