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JAMA Intern Med:艰难梭菌感染:万古霉素还是甲硝唑?

2017-04-24 何娜;常路 环球医学

盐酸甲硝唑历来被认为是轻度至中度艰难梭菌感染(CDI)患者的一线治疗,但是在临床治愈上不如盐酸万古霉素。同样,治疗选择对其他下游结局具有实质性影响,如复发和死亡,但是对这些次要结局的研究很少。2017年4月,发表在《JAMA Intern Med》的一项回顾性、倾向得分匹配的队列研究调查了接受甲硝唑或万古霉素治疗的轻度至中度和重度CDI患者的复发和30天全因死亡风险。目的:旨在评估接受甲硝唑或万古



盐酸甲硝唑历来被认为是轻度至中度艰难梭菌感染(CDI)患者的一线治疗,但是在临床治愈上不如盐酸万古霉素。同样,治疗选择对其他下游结局具有实质性影响,如复发和死亡,但是对这些次要结局的研究很少。2017年4月,发表在《JAMA Intern Med》的一项回顾性、倾向得分匹配的队列研究调查了接受甲硝唑或万古霉素治疗的轻度至中度和重度CDI患者的复发和30天全因死亡风险。

目的:旨在评估接受甲硝唑或万古霉素治疗的轻度至中度和重度CDI患者的复发和30天全因死亡风险。

设计、设置和参与者:本回顾性、倾向得分匹配的队列研究评估了2005年1月1日~2012年12月31日美国退伍军人事务管理部医疗保健系统的CDI治疗的患者,其定义为粪便样本中艰难梭菌毒素或毒素基因的实验室检查结果阳性。2015年2月7日~2016年11月22日进行了数据分析。

暴露:万古霉素或甲硝唑治疗。

主要结局和测量:本研究的主要结局为CDI复发和30天全因死亡率。复发的定义为初始CDI诊断的8周内,第二次实验室检查结果阳性。30天全因死亡率的定义为初始CDI诊断的30天内任何原因造成的死亡。

结果:总共47471名发生CDI的接受万古霉素或甲硝唑治疗的患者(平均(SD)68.8(13.3)岁,1947人为女性(4.1%),45524人为男性(95.9%))符合研究的入组标准。47147例符合条件的第一次治疗发作中,2068例(4.4%)接受万古霉素治疗。将这2068名患者与甲硝唑组中的8069名患者进行了配对,因此研究总共纳入了10137名患者。子队列的组成为5452名轻度至中度疾病的患者和3130名重度疾病的患者。任何疾病严重程度的队列中,万古霉素与甲硝唑治疗的患者间,在复发风险上都没差异。任何疾病严重程度的队列患者中,万古霉素治疗的患者死亡的可能性较小(调整相对风险,0.86;95% CI,0.74~0.98;调整风险差异,-0.02;95% CI,-0.03~-0.01)。轻度至中度CDI的患者中,治疗组间在死亡风险上没有显着性差异,但是万古霉素可显着降低重度CDI患者的30天全因死亡风险(调整相对风险,0.79;;95% CI,0.65~0.97;调整风险差异,-0.04;95% CI,-0.07~-0.01)。

结论和意义:万古霉素和甲硝唑治疗的患者间,复发率相似。但是,万古霉素治疗患者的30天全因死亡风险显着降低。该研究结果进一步证明了万古霉素作为重度CDI初始治疗的使用。

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    2017-05-04 cuiyejia

    学习了,谢谢

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=193681, encodeId=056f19368145, content=学习了,谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28761705280, createdName=cuiyejia, createdTime=Thu May 04 12:25:13 CST 2017, time=2017-05-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=193298, encodeId=c60719329825, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/101296147/1A51842815047D40BFDAA8D69AA8E519/100, createdBy=fd7f2029163, createdName=绛珠草小姐, createdTime=Wed May 03 15:03:47 CST 2017, time=2017-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1299283, encodeId=fa42129928314, content=<a href='/topic/show?id=5413699307e' target=_blank style='color:#2F92EE;'>#甲硝唑#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69930, encryptionId=5413699307e, topicName=甲硝唑)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3860283, createdName=whmdzju, createdTime=Wed Apr 26 10:23:00 CST 2017, time=2017-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1607429, encodeId=e67a160e42947, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Wed Apr 26 10:23:00 CST 2017, time=2017-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=190255, encodeId=dc5119025548, content=最好是微生物治疗, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4a5105539, createdName=lovetcm, createdTime=Mon Apr 24 21:51:10 CST 2017, time=2017-04-24, status=1, ipAttribution=)]
    2017-05-03 绛珠草小姐

    学习了,谢谢分享

    0

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    2017-04-26 whmdzju
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    2017-04-24 lovetcm

    最好是微生物治疗

    0

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