Clostridium difficile-associated disease에 사용되는 경구용 Vancomycin의 사용 실태 및 치료실패에 영향을 미치는 요인 분석
Evaluation of Oral Vancomycin Use for the Treatment of Clostridium Difficile-Associated Disease and Risk Factor Analysis of Treatment Failure
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
The number of Clostridium difficile-associated disease(CDAD) event and mortality of CDAD have been increasing due to the emergence of mutant BI/NAP1/027 which can produce C.difficile toxin about 10~20 times more than the existing C.difficile. According to the clinical practice guideline from Society for Healthcare Epidemiology of America (SHEA) and the Society for Healthcare Epidemiology of America (SHEA), prescribing oral metron-idazole or oral vancomycin for 10~14 days depending on clinical status is recommended for adult Clostridium difficile infection. This study aimed to evaluate oral vancomycin use for the treatment of CDAD and analyze the risk factor for treatment failure. Clinical data of CDAD patient who treated with oral vancomycin from April 2008 to August 2010 were retrospectively reviewed. We classified patients into two groups, depending on the clinical outcome on the 10th day and identified risk factor of treatment failure. Seventy two patients were included in this analysis. Forty eight patients (66.7%) and sixty one patients (84.7%) recovered from CDAD on the 10th day of treatment and by 28th days from the start of oral vancomycin. Patients with high disease severity score and patients who defecate more than six times a day at the time of treatment start are more likely to experience treatment failure.
Abstract
The number of Clostridium difficile-associated disease(CDAD) event and mortality of CDAD have been increasing due to the emergence of mutant BI/NAP1/027 which can produce C.difficile toxin about 10~20 times more than the existing C.difficile. According to the clinical practice guideline from Society for Healthcare Epidemiology of America (SHEA) and the Society for Healthcare Epidemiology of America (SHEA), prescribing oral metron-idazole or oral vancomycin for 10~14 days depending on clinical status is recommended for adult Clostridium difficile infection. This study aimed to evaluate oral vancomycin use for the treatment of CDAD and analyze the risk factor for treatment failure. Clinical data of CDAD patient who treated with oral vancomycin from April 2008 to August 2010 were retrospectively reviewed. We classified patients into two groups, depending on the clinical outcome on the 10th day and identified risk factor of treatment failure. Seventy two patients were included in this analysis. Forty eight patients (66.7%) and sixty one patients (84.7%) recovered from CDAD on the 10th day of treatment and by 28th days from the start of oral vancomycin. Patients with high disease severity score and patients who defecate more than six times a day at the time of treatment start are more likely to experience treatment failure.
참고문헌 (15)
- Stuart H., "Clinical Practice Guidelines for Clostridium difficile Infection in Adults", 2010 Update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA), ~ (2010)
- Perry Hookman, "Guidelines for Prevention, Surveillance, Diagnosis, and Treatment, in this New Era of More Virulent Strains of Antibiotic Associated Diarrhea (AAD), Clostridium Difficile-Associated Diseases", Diarrhea (CDAD) and Clostridium Difficile Colitis (CDAC, 2006, pp.65~82
- Jacques pepin, "Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity", CMAJ August, 171(5) (2004)
- B. Faris, "Review of medical and surgical management of Clostridium difficile infection", Tech Coloproctol, 14, pp.97~105 (2010)
- Dale N. Gerding, "Treatment of Clostridium difficile Infection", CID, 46(Suppl 1) (2008)
- 이윤정, "최근 10년간 Clostridium difficile 대장염의 임상 양상 변화", 대한소화기학회지, 55(3), pp.169~174 (2010), 대한소화기학회
- 박혜선, "항생제 연관 설사의 치료", 대한소화기학회지, 54(1), pp.5~12 (2009), 대한소화기학회
- 이진호, "Clostridium difficile 감염의 발생률 및 임상 양상; 단일기관 연구", 대한소화기학회지, 55(3), pp.175~182 (2010), 대한소화기학회
- Teasley D.G., "Prospective randomised trial of metronidazole versus vancomycin for Clostridium-difficile-associated diarrhoea and colitis", Lancet, 2(8358), pp.1043~1046 (1983)
- Wenisch C., "Comparison of vancomycin, teicoplanin, metronidazole, and fusidic acid for the treatment of Clostridium difficile-associated diarrhea", Clin Infect Dis, 22(5), pp.813~818 (1996)
- Zar F.A., "A comparison of vancomycin and metronidazole for the treatment of Clostridium difficile-associated diarrhea, stratified by disease severity", Clin Infect Dis, 45(3), pp.302~307 (2007)
- Angel Fernandez, "Factors Associated With Failure of Metronidazole in Clostridium difficile-associated Disease", J Clin Gastroenterol, 38(5) (2004)
- Wafa N. Al-Nassir, "Comparison of Clinical and Microbiological Response to Treatment of Clostridium difficile- Associated Disease with Metronidazole and Vancomycin", CID, 47 (2008)
- Andrew E. Simor, "Diagnosis, Management, and Prevention of Clostridium difficile Infection in Long- Term Care Facilities: A Review", JAGS, 58, pp.1556~1564 (2010)
- Mohammed Aseeri, "Gastric Acid Suppression by Proton Pump Inhibitors as a Risk Factor for Clostridium difficile- Associated Diarrhea in Hospitalized Patients", Am J Gastroenterol, 103, pp.2308~2313 (2008)