74 Chapter 4 Antibiotic regimens For the treatment of complicated colonization in this cohort, 12 different combinations of antibiotic agents were prescribed with a duration ranging from 5 to 14 days. The most frequently prescribed combinations of antibiotic agents were doxycycline-rifampicin, trimethoprim (with or without sulfamethoxazole)- rifampicin and clindamycin-rifampicin. The success rates of the different antibiotic combinations at the consecutive decolonization attempts are summarized in Table 4. In the first treatment attempt, the combination of doxycycline-rifampicin showed the highest success rate (32/37, 86%) compared to trimethoprim(/sulfamethoxazole)- rifampicin (41/60, 68%), clindamycin-rifampicin (15/19, 79%) and ‘other regimens’ (9/15, 60%). The difference in success rate at first attempt of doxycycline-rifampicin versus all other regimens did not reach statistical significance (86 versus 69%, OR 2.20, 95%CI 0.77-6.31, p=0.16). There was no difference in outcome of addition of trimethoprim alone (success rate 19/24, 79%; 95%CI 58-93) or in combination with sulfamethoxazole (success rate 22/31, 71%; 95%CI 52-86). Prolonged antibiotic treatment (10-14 days) was not associated with better treatment outcome (49/64; 77%) compared to a 7-day treatment (40/51; 78%) (OR 0.99, 95%CI 0.39-2.53, p=1.00). There was a trend towards a higher success rate in the patients in whom the guideline for treatment choice was followed (88/115; 77%) compared to the patients in whom the guideline was not followed (6/12; 50%, 95%CI 0.97-10.94, p=0.08). Predictive variables In the univariate risk analysis, being part of a known household cluster (OR 2.38, 95%CI 1.01-5.61, p= 0.05) and an immunocompromised status (OR 6.27, 95%CI 1.8121.68, p <0.01) were associated with failure at first decolonization attempt (Table 5). Panton Valentin Leucocidin (PVL) was tested in 88 patients and was positive in 27/88 (31%). There was no correlation between PVL positivity and success of eradication in these patients (OR 0.57, 95%CI 0.15-1.82, p=0.36). In the multivariable analysis an immunocompromised status remained an independent risk factor for failure at the first treatment attempt (OR 4.83, 95%CI 1.34-17.45, p=0.02) (Table 5).
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