Program Schedule

1653
Results of a Treatment Protocol Encouraging First-Line Use of Fidaxomicin for Select Patients with Clostridium difficile Infection (CDI)

Session: Poster Abstract Session: Clostridium difficile Infection: Epidemiology, Presentation, Treatment
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • IDSA poster CDI.pdf (1.1 MB)
  • Background: Large comparative trials found fidaxomicin to decrease recurrence rates relative to vancomycin for CDI. The price of fidaxomicin makes universal use cost-prohibitive. This study evaluates outcomes of patients who received fidaxomicin or vancomycin after a pathway encouraging fidaxomicin use for recurrent or serious CDI.

    Methods: This was a single-center retrospective study of patients who received vancomycin or fidaxomicin for CDI during January 2012-January 2014. By protocol patients were eligible for fidaxomicin if they experienced a recurrent CDI or had 2 of 4 of: immunocompromising conditions; concomitant antibiotics; age>65 years; lab values of WBC >15K, SCr rise 1.5x baseline, or albumin <3 gm/dL. Included patients were adults with C. difficile positive assays and acute diarrhea. All included patients were fidaxomicin-eligible per the institution protocol. Patients who failed initial therapy for the CDI episode were excluded. Baseline and clinical characteristics were collected. The primary outcome was readmissions due to recurrence of CDI within 90 days. Data were analyzed by Chi-square and t-test as appropriate and logistic regression with readmission as a binary variable was performed to determine characteristics associated with recurrence.

    Results:  

    Variable

    Vancomycin (n=46)

    Fidaxomicin (n=49)

    P-value

    Age (mean ± SD)

    72.1 ± 10.1

    73.2 ± 11.8

    0.64

    Length of stay (mean ± SD)

    10.6 ± 7.42

    8.96 ± 725

    0.26

    ICU (n, %)

    9 (19.6%)

    13 (26.5%)

    0.42

    Current CDI episode was recurrence of earlier infection (n, %)

    22 (47.8%)

    38 (77.6%)

    0.008

    Concomitant antibiotics (n, %)

    14 (30.4%)

    24 (49.0%)

    0.065

    Creatinine >1.5x baseline (n, %)

    9 (19.6%)

    18 (36.7%)

    0.064

    Moderate or severe CDI (n, %)

    23 (50%)

    34 (69.4%)

    0.154

    Readmission with CDI within 90 days (n, %)

    19 (41.3%)

    10 (20.4%)

    0.027

    On multivariate analysis that included treatment, severity of initial CDI, creatinine increase, and concomitant antibiotics, treatment with fidaxomicin was associated with lower risk of readmission with CDI (OR 0.33, 95% CI 0.12-0.93)

    Conclusion: Treatment with fidaxomicin according to institutional protocol in our population was associated with less 90-day readmission due to CDI and may be cost-effective when readmission is taken into consideration.

    Bhagyashri Navalkele, MD1, Gemma Downham, MPH, CIC1, Kevin Haynes, PharmD, MSCE2, Jason Gallagher, PharmD, FCCP, BCPS3, Joseph Reilly, PharmD, MSCE1 and Manish Trivedi, MD1, (1)AtlantiCare Regional Medical Center, Atlantic City, NJ, (2)University of Pennsylvania School of Medicine, Philadelphia, PA, (3)Temple University, Philadelphia, PA

    Disclosures:

    B. Navalkele, None

    G. Downham, None

    K. Haynes, None

    J. Gallagher, Cubist: Consultant, Consulting fee
    Optimer: Scientific Advisor and Speaker's Bureau, Consulting fee and Speaker honorarium
    Astellas: Speaker's Bureau, Speaker honorarium

    J. Reilly, Optimer: Speaker's Bureau, Speaker honorarium
    Cubist: Speaker's Bureau, Speaker honorarium

    M. Trivedi, Optimer: Speaker's Bureau, Speaker honorarium

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