Methods: Single-center, retrospective, cohort of adult patients admitted to an ICU between April 2016 and April 2018 with a positive C. difficile nucleic acid amplification test and an order for PO VAN were screened for inclusion. Patients were excluded if they had life-threatening intra-abdominal complications, including toxic megacolon/emergent colectomy. The primary outcome was 30-day in-hospital all-cause mortality. In a subgroup analysis, patients were matched using Acute Physiology and Chronic Health Evaluation (APACHE) II scores. Logistic regression was conducted to identify clinical variables associated with mortality.
Results: 101 patients were included; 47 received combination therapy with IV MDZ. Baseline characteristics were similar across groups, except patients in the IV MDZ group had a higher median white blood cell (WBC) count at diagnosis (18.4 vs 13.9, P = 0.023) and were more likely to receive a higher dose (500 mg) of PO VAN (36.2% vs 7.4%, P <0.0001). Thirty-day mortality was 14.9% in the combination group vs 7.4% in the monotherapy group, (P = 0.338). APACHE II Score was the only variable independently associated with 30-day mortality (OR = 1.13, 95% CI 1.03 – 1.24). There was no difference in probability of receiving IV MDZ based on APACHE II score. In a subgroup of patients matched by APACHE II Score (n = 76), mortality remained non-significantly different (15.8% vs 9.7%, P = 0.480).
Conclusion: Our data questions the utility of IV MDZ in addition to PO VAN for ICU patients with severe CDI. There remains a possibility for confounding by indication in this retrospective analysis.
E. Heil, ALK-AbellÃ³: Grant Investigator , Research grant .
J. Johnson, None
S. Leekha, None
K. Claeys, Nabriva: Scientific Advisor , Consulting fee . Melinta: Scientific Advisor , Consulting fee .