{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T14:18:02Z","timestamp":1791296282508,"version":"4.1.0"},"reference-count":21,"publisher":"American Society for Microbiology","issue":"10","license":[{"start":{"date-parts":[[2015,10,1]],"date-time":"2015-10-01T00:00:00Z","timestamp":1443657600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Antimicrob Agents Chemother"],"published-print":{"date-parts":[[2015,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>\n            Consensus on the optimal treatment of\n            <jats:named-content xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" content-type=\"genus-species\" xlink:type=\"simple\">Clostridium difficile<\/jats:named-content>\n            infection (CDI) is rapidly changing. Treatment with metronidazole has been associated with increased clinical failure rates; however, the reasons for this are unclear. The purpose of this study was to assess age-related treatment response rates in hospitalized patients with CDI treated with metronidazole. This was a retrospective, multicenter cohort study of hospitalized patients with CDI. Patients were assessed for refractory CDI, defined as persistent diarrhea after 7 days of metronidazole therapy, and stratified by age and clinical characteristics. A total of 242 individuals, aged 60 \u00b1 18 years (Charlson comorbidity index, 3.8 \u00b1 2.4; Horn's index, 1.7 \u00b1 1.0) were included. One hundred twenty-eight patients (53%) had severe CDI. Seventy patients (29%) had refractory CDI, a percentage that increased from 22% to 28% and to 37% for patients aged less than 50 years, for patients from 50 to 70 years, and for patients aged &gt;70 years, respectively (\n            <jats:italic>P<\/jats:italic>\n            = 0.05). In multivariate analysis, Horn's index (odds ratio [OR], 2.04; 95% confidence interval [CI], 1.50 to 2.77;\n            <jats:italic>P<\/jats:italic>\n            &lt; 0.001), severe CDI (OR, 2.25; 95% CI, 1.15 to 4.41;\n            <jats:italic>P<\/jats:italic>\n            = 0.018), and continued use of antibiotics (OR, 2.65; 95% CI, 1.30 to 5.39;\n            <jats:italic>P<\/jats:italic>\n            = 0.0072) were identified as significant predictors of refractory CDI. Age was not identified as an independent risk factor for refractory CDI. Therefore, hospitalized elderly patients with CDI treated with metronidazole had increased refractory CDI rates likely due to increased underlying severity of illness, severity of CDI, and concomitant antibiotic use. These results may help identify patients that may benefit from alternative\n            <jats:named-content xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" content-type=\"genus-species\" xlink:type=\"simple\">C. difficile<\/jats:named-content>\n            treatments other than metronidazole.\n          <\/jats:p>","DOI":"10.1128\/aac.00816-15","type":"journal-article","created":{"date-parts":[[2015,7,21]],"date-time":"2015-07-21T00:23:30Z","timestamp":1437438210000},"page":"6113-6116","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":11,"title":["Age-Stratified Treatment Response Rates in Hospitalized Patients with Clostridium difficile Infection Treated with Metronidazole"],"prefix":"10.1128","volume":"59","author":[{"given":"Vy P.","family":"Pham","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Memorial Hermann Northwest Hospital, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea M.","family":"Luce","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, Texas A&amp;M Irma Lerma Rangel College of Pharmacy, Kingsville, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara C.","family":"Ruppelt","sequence":"additional","affiliation":[{"name":"Department of Research and Sponsored Programs, Harris Health System, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjing","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Parkland Health and Hospital System, Dallas, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel L.","family":"Aitken","sequence":"additional","affiliation":[{"name":"Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William L.","family":"Musick","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Houston Methodist Hospital, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan K.","family":"Roux","sequence":"additional","affiliation":[{"name":"Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin W.","family":"Garey","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas, 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