758. A Comparison of the Outcomes of Metronidazole-treated Patients with Clostridium difficile Infection (CDI) using the IDSA/SHEA Clinical Practice Severity of Illness Guidelines
Session: Oral Abstract Session: Clostridium difficile: Detection, Transmission, and Treatment
Friday, October 21, 2011: 3:30 PM
Room: 151AB
Background: Treatment guidelines published by the IDSA/SHEA recommend the use of metronidazole (MZ) for patients with mild/moderate CDI and vancomycin for those with severe disease. The criteria for severity of illness used in the guidelines for treatment recommendations have not been validated in independent studies. We evaluated outcomes of patients treated for CDI with MZ based on severity of illness to evaluate the clinical utility of these guidelines. 

Methods: We retrospectively evaluated the 30-day mortality of adult patients treated for CDI with MZ from 11/2005-8/2006.  The following patient data were collected:  demographics, length of stay, duration of treatment, clinical improvement within 5 days, relapses, and 30-day all-cause mortality.  Relapses were defined as diarrhea or positive stool antigen assay within 30 days after completion of prior treatment.  Patients were defined as mild/moderate or severe using the severity scoring system provided in the guidelines (Cohen SH, ICHE, 2010). Data were compared using X2 for categorical variables and Student’s t test for continuous variables.  Statistical analysis was performed using SPSS v. 19.0 and a p<0.05 was considered significant.

Results: Among 92 patients treated with MZ for CDI, 45 (48.9%) were defined as mild/moderate and 47 (51.1%) as severe disease. There were no differences between patient with mild and severe disease with respect to age, length of stay, or duration of treatment. There were no differences in patients with mild/moderate vs. severe disease in terms of 5 day clinical improvement (64.9% vs. 56.8%, p=0.41) or relapses (27.5% vs. 16.2%, p=0.23).   There was a significantly higher 30-day all cause mortality in those with severe vs. mild/moderate disease (34% vs.15%, p=0.044).

Conclusion: The use of MZ in patients with severe CDI as defined by the IDSA/SHEA guidelines is associated with increased risk of 30-day all cause mortality.  Patients with severe CDI should receive alternate agents. 

Subject Category: J. Clinical practice issues

Anilrudh Venugopal, MD1,2, Susan Szpunar, PhD2, Robert Sessions, BS2 and Leonard Johnson, MD1,2, (1)School of Medicine, Wayne State University, Grosse Pointe Woods, MI, (2)St. John Hospital and Medical Center, Grosse Pointe Woods, MI


A. Venugopal, None

S. Szpunar, None

R. Sessions, None

L. Johnson, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.