Korean J Clin Pharm.  2018 Sep;28(3):174-180. 10.24304/kjcp.2018.28.3.174.

Drug Use Evaluation of Clostridium difficile Infection in Elderly Patients and Risk Factors of Non-improving Group

• Noh HJ
• Ham JY
• Lee JG
• Rhie SJ

• KMID: 2438542
• DOI: http://doi.org/10.24304/kjcp.2018.28.3.174

Abstract

OBJECTIVE
Clostridium difficile Infection (CDI) is one of the common nosocomial infections. As elderly population increases, the proper 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 retrospective study using electronic medical record at Kangbuk Samsung Medical Center (KBSMC) from January 2016 to December 2017. Seventy three patients aged 65 years or older, diagnosed with CDI by Clostridium difficile Toxin B Gene [Xpert] were screened and they were 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, total days of use and treatment outcome of initial therapy.
RESULTS
Out of 73 patients aged over 65 years, four patients were excluded because they did not receive any treatment. There were 31 improved patients and 38 unimproved patients after initial therapy. We were able to find out patients with surgical comorbidity or endocrine comorbidity (especially, diabetes mellitus) had 2.885 more risk of becoming unimproved than those patients without surgical comorbidity or endocrine comorbidity. Drug use evaluation for CDI was 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 these risk factors. However, the study is meaningful because the number of elderly population keeps increasing and recently updated guideline suggests the use of vancomycin as drug of choice for CDI.

Keyword

Clostridium difficile; elderly; drug use; Clostridium difficile infection

MeSH Terms

Aged*
Antacids
Anti-Bacterial Agents
Clostridium difficile*
Clostridium*
Comorbidity
Cross Infection
Electronic Health Records
Humans
Metronidazole
Outpatients
Retrospective Studies
Risk Factors*
Treatment Outcome
Vancomycin
Antacids
Anti-Bacterial Agents
Metronidazole
Vancomycin