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Shah et al
may differ from other institutions and the data available was
dependent on accurate recording at the time of hospitalization. Also, the retrospective design of this study did not allow
the investigators to assess other traditional outcomes such as
diarrhea resolution. Second, patients who improved rapidly
with initial VAN therapy were frequently discharged to complete therapy with MDZ. However, drug selection and adherence to discharge antibiotic regimens would not have
impacted our main outcomes as they were all assessed at
either end of therapy or hospital discharge. Third, because of
the wide range of nephrotoxic agents, investigators were
unable to account for concomitant use every nephrotoxic
drug. This may have impacted outcomes pertaining serum
creatinine. Fourth, a formal comorbidity index was not performed in this study. However, investigators specifically
obtained comorbidities that may worsen CDI and increase
the risk of CDI recurrence. Fifth, the small sample size in this
study may have limited our ability to detect a statistically
significant difference in the primary outcome of all-cause inhospital mortality.
Our study supports the conclusion that patients who
develop severe CDI, as defined by a WBC count greater than
15 000 cells/mm3, should receive oral VAN as their initial
treatment. However, due to the small sample size of this
study, larger studies of this clinical question would help
strengthen these findings and further elucidate the benefit, if
any, for reducing mortality.
Acknowledgments
The authors wish to thank Lucia Rose', PharmD and Madeline
King, PharmD for their support on this project.

Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.

ICMJE Statement
All authors meet the ICMJE authorship criteria.

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