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OBJECTIVE

To reassess the comparative efficacy of vancomycin versus metronidazole in the treatment of Clostridium difficile-associated disease (CDAD) after the emergence in 2003 of the hypervirulent NAP1/027 strain.

METHODS

A retrospective cohort study was conducted in a tertiary-care Canadian hospital among 1,616 patients treated initially with metronidazole (N= 1,360), vancomycin (N= 219), or both (N= 37), between 1991 and 2006, and followed for 60 days after diagnosis. Primary outcome was severe/complicated CDAD (SC-CDAD) defined as any of:(a) death within 30 days,(b) septic shock,(c) megacolon,(d) perforation, or (e) emergency colectomy. Adjusted odds ratios (AOR) and their 95% confidence intervals (CI) were calculated, stratifying into pre-epidemic (1991–2002) and epidemic (2003–2006) periods. Secondary outcome was recurrence within 60 days.

RESULTS

Risk factors for SC-CDAD were …