The Society for Healthcare Epidemiology (SHEA) and the Infectious Diseases Society of America (IDSA) clinical practice guidelines for Clostridium difficile infection (CDI) help to define and make recommendations for the treatment of mild to moderate disease with metronidazole and severe disease with vancomycin. We retrospectively evaluated 285 patients who were initially treated with metronidazole and stratified them by severity of illness using the guideline criteria. We compared the outcomes in the 2 groups including the need to change therapy, recurrences, and 30-day all-cause mortality. There were no differences in recurrence rates based on severity of disease. From the multivariate analysis, severe CDI was predictive of 30-day all-cause mortality (odds ratio (OR) 1.98, 95% confidence interval (CI) 1.07-3.67, p = 0.03), after controlling for ICU stay prior to diagnosis (OR 2.94, 95% CI 1.60-5.41. p = 0.001), age (OR 1.02, 95% CI 1.004-1.05, p = 0.02), and the modified Charlson score (OR 1.31, 95% CI 1.14-1.49, p < 0.0001).
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