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Drug Use Evaluation of Clostridium difficile Infection in Elderly Patients and Risk Factors of Non-improving Group
Korean J Clin Pharm 2018;28(3):174-180
Published online September 30, 2018
© 2018 Korean College of Clinical Pharmacy.

Hyun Jeong Noh1,2, Jung Yeon Ham2, Ja Gyun Lee2, and Sandy Jeong Rhie1,3*

1Graduate School of Converging Clinical & Public Health, Ewha Womans University, Seoul 03760, Republic of Korea
2Department of Pharmacy, Kangbuk Samsung Medical Center, Seoul 03181, Republic of Korea
3Division of Life and Pharmaceutical Science and College of Pharmacy, Ewha Womans University, Seoul 03760, Republic of Korea
Correspondence to: Sandy Jeong Rhie, Graduate School of Converging Clinical & Public Health, Division of Life and Pharmaceutical Science and College of Pharmacy, Ewha Womans University, Seoul 03760, Republic of Korea
Tel: +82-2-3277-3023, Fax: +82-2-3277-2851
E-mail: sandy.rhie@ewha.ac.kr
Received September 5, 2018; Revised September 21, 2018; Accepted September 21, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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.
Keywords : Clostridium difficile, elderly, drug use, Clostridium difficile infection


September 2018, 28 (3)
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