The influence of the use of metronidazole associated with vancomycin in reducing the mortality rate at 30 days in patients with Clostridium difficile infection

Background: Clostridium difficile infection (CDI) still remains the most common cause of nosocomial diarrhea. We assumed that the death rate at 30 days could be influenced by the etiological therapy, monotherapy (vancomycin) alone versus the association of vancomycin with metronidazole. We considered as a secondary factor the association of chronic treatment with statins. Methods: We assume that the administration of the actual etiological therapy at patients having CDI cannot be postulated as being similar for all molecules used alone or in combination, in all aspects, including the concerns regarding the mortality rates within 30 d, requiring concrete data related to this issue. We aimed to assess the mortality rate within 30 d in patients with CDI. We conducted an analytical, observational study. We have developed a logistic regression model to verify our hypothesis. The model is testing what are the factors increasing the odds of survival after treating the CDI at 30 d. Results: The 525 enrolled patients were divided into two groups: statin non-users (n=454) and statin users (n=71). The antimicrobial exposure, the proton pump inhibitors exposure in last 60 d and the relapse rate were similar in both groups, but the death rate was lower in the group of patients that received as chronic treatment statins (1.4% versus 8.6%). Conclusions: The addition of intravenous metronidazole to oral vancomycin for the treatment of CDI is associated with a significant reduction of the odds of death within 30 d