A Comparison of Vancomycin and Metronidazole for the Treatment of Clostridium difficile-associated Diarrhea (CDAD) in Medical Intensive Care Unit (MICU)

BACKGROUND: Clostridium difficile associated diarrhea (CDAD) is a leading cause of hospital-associated gastrointestinal illness. Risk factors for CDAD include advanced age, long-term admission, antibiotics, proton-pump inhibitor or H₂ blocker use and immunosuppression. The practice guideline of American Journal of Gastroenterology (2013) suggests metronidazole for the first-line therapy of mild-moderate CDAD as well as vancomycin for severe CDAD. MICU inpatients receiving stress ulcer prophylaxis and antibiotics are susceptible to nosocomial CDAD. Therefore, this study aimed to evaluate occurrence and treatment of CDAD in MICU. METHODS: Patients who were admitted to the MICU and had CDAD from August 2012 to August 2015 were analyzed retrospectively. RESULTS: Of the 90 patients with CDAD, 20 patients (2.22%) had mild-moderate CDAD (16 received metronidazole and 4 received vancomycin therapy) and 70 patients (77.8%) had severe CDAD(54 received metronidazole and 16 received vancomycin therapy). Among the patients with mild-moderate CDAD, treatment with metronidazole or vancomycin resulted in same clinical cure in 50% of the patients (p=1.00). Among the patients with severe CDAD, treatment with metronidazole or vancomycin resulted in clinical cure in 40.7% and 50.0% of the patients, respectively (p=0.511). Clinical symptoms recurred in 7.4% of the severe CDAD patients treated with metronidazole and 6.3% of those treated with vancomycin (p=0.875). CONCLUSION: Our findings suggest that metronidazole and vancomycin are equally effective for the treatment of mild-moderate CDAD; however, vancomycin demonstrated higher clinical cure rate and lower recurrence rate for severe CDAD, although the difference was not statistically significant. For better clinical outcomes, appropriate medication use by disease severity is needed.

A clinical study of percutaneous tracheostomy in medical ICU by non surgical doctors.

Introduction: Tracheostomy is one of the oldest surgical procedures to access the airway. The majority of cases who require tracheostomy are in ICUs. The ICUs are monitored by intensivists who are mostly Anesthesiologists or Physicians (non-surgical personnel). While doing surgical tracheostomy, there is dependency on other departments like surgeons of ENT department. In most cases, critically ill patients are made to shift to operating room, where we may have to wait for the availability of operating table. Method: This clinical study was carried out to access the airway when required by nonsurgical doctors like anesthesiologists or physicians at bed side and to save cost and operation theatre time. Result: Sixteen male & twelve female patients with an average age of 28 Years (range, 19 to 40Years) underwent PCT from Oct. 2008 to Oct.2011. Fourteen patients were of snake bite, 10 were of organo-phosphorus poisoning & 4 were of G.B. Syndrome. Conclusion: Percutaneous tracheostomy has replaced the surgical route in several intensive care units and it is indeed the procedure of choice in the majority of cases. [Rajan N NJIRM 2014; 5(1):6-9] Key Words: Percutaneous Tracheostomy (PCT), Surgical Tracheostomy (ST), Medical intensive care unit (MICU), critically ill, complications, tracheal injury, bleeding.