Predictors associated with failure of metronidazole in treatment of clostridium difficile infection in the elderly

. Clostridium difficile is the most common infectious cause of nosocomial diarrhea. Recommended treatments for Clostridium difficile infection include metronidazole and vancomycin. Recent investigation has shown an increasing rate of metronidazole treatment failure, particularly among the elderly. The authors studied the outcome of metronidazole therapy for Clostridium difficile infection in patients over 65 years of age and risk factors associated with metronidazole treatment failure. Material and Methods. This retrospective study was performed at the Department of Infectious Diseases, Clinical Center of Vojvodina from January 2011 to January 2014. The study sample included 112 patients, over 65 years of age, diagnosed with Clostridium difficile infection, who were treated with oral metronidazole 400 mg 3 times per day for 10 days. The efficacy of treatment regimen was assessed by resolution of diarrhea and rates of recurrence within 60 days after completion of therapy Results. Metronidazole was administrated to 112 patients over 65 years of age. Treatment with metronidazole resulted in resolution of diarrhea in 78 patients (69.65%). After successful metronidazole treatment, clinical symptoms of Clostridium difficile infection recurred in 28 the patients (36.60%) . Risk factors for metronidazole treatment failure are duration of diarrhea before treatment, leucocytosis >15 000/mm3, albumin level ≤25 g/l, serum creatinine level ≥200 μmol/l, increased C-reactive protein, and concomitant administration of antibiotic and immunosuppressives. Conclusion. Our data suggest that patients with predictors of metronidazole treatment failure may benefit from initial oral vancomycin therapy for Clostridium difficile infection