노인층에서 Clostridium difficile 감염 약물사용평가 및 비호전군에 대한 영향인자
Drug Use Evaluation of Clostridium difficile Infection in Elderly Patients and Risk Factors of Non-improving Group
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Objective: Clostridium difficile Infection (CDI) is one of the common nosocomial infections. As elderly population increases, theproper treatment has been emphasized. We investigated the risk factors associated with CDI unimprovement in elderly patients. Furthermore, we performed drug use evaluation of old CDI patients and oldest-old CDI patients. Methods: It was a retrospectivestudy using electronic medical record at Kangbuk Samsung Medical Center (KBSMC) from January 2016 to December 2017. Seventythree patients aged 65 years or older, diagnosed with CDI by Clostridium difficile Toxin B Gene [Xpert] were screened and theywere assessed for risk factors regarding unimprovement status. We also evaluated drug use evaluation in old patients (65≤age<80)and oldest-old patients (80≤age) by assessing the use of initial therapy, severity, dose, route, treatment course, days of use, totaldays of use and treatment outcome of initial therapy. Results: Out of 73 patients aged over 65 years, four patients were excludedbecause they did not receive any treatment. There were 31 improved patients and 38 unimproved patients after initial therapy. Wewere able to find out patients with surgical comorbidity or endocrine comorbidity (especially, diabetes mellitus) had 2.885 more riskof becoming unimproved than those patients without surgical comorbidity or endocrine comorbidity. Drug use evaluation for CDIwas generally fair, but vancomycin as initial therapy is more recommended than metronidazole. Conclusion: Although age,antibiotics exposure, use of antacids are all important risk factors for CDI, our result did not show statistical significance for theserisk factors. However, the study is meaningful because the number of elderly population keeps increasing and recently updatedguideline suggests the use of vancomycin as drug of choice for CDI.
Abstract
Objective: Clostridium difficile Infection (CDI) is one of the common nosocomial infections. As elderly population increases, theproper treatment has been emphasized. We investigated the risk factors associated with CDI unimprovement in elderly patients. Furthermore, we performed drug use evaluation of old CDI patients and oldest-old CDI patients. Methods: It was a retrospectivestudy using electronic medical record at Kangbuk Samsung Medical Center (KBSMC) from January 2016 to December 2017. Seventythree patients aged 65 years or older, diagnosed with CDI by Clostridium difficile Toxin B Gene [Xpert] were screened and theywere assessed for risk factors regarding unimprovement status. We also evaluated drug use evaluation in old patients (65≤age<80)and oldest-old patients (80≤age) by assessing the use of initial therapy, severity, dose, route, treatment course, days of use, totaldays of use and treatment outcome of initial therapy. Results: Out of 73 patients aged over 65 years, four patients were excludedbecause they did not receive any treatment. There were 31 improved patients and 38 unimproved patients after initial therapy. Wewere able to find out patients with surgical comorbidity or endocrine comorbidity (especially, diabetes mellitus) had 2.885 more riskof becoming unimproved than those patients without surgical comorbidity or endocrine comorbidity. Drug use evaluation for CDIwas generally fair, but vancomycin as initial therapy is more recommended than metronidazole. Conclusion: Although age,antibiotics exposure, use of antacids are all important risk factors for CDI, our result did not show statistical significance for theserisk factors. However, the study is meaningful because the number of elderly population keeps increasing and recently updatedguideline suggests the use of vancomycin as drug of choice for CDI.
참고문헌 (16)
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