Methods: A retrospective chart review was conducted for the patients who had fidaxomicin orders between Jan. 1, 2013, and Nov. 18, 2014 in the Sinai Hospital, Baltimore, MD. We evaluated if the subjects fulfill the following Fidaxomicin Approval Criteria of Sinai Hospital (FACSH) in treatment of moderate or severe CDAD in patient; 1) who has failed to improve after 7 days of oral vancomycin treatment;2) who had > 2 hospital admissions within the past 6 months due to C. difficile colitis;3) who is hospitalized due to recurrence within 1 month of completing oral vancomycin treatment. Treatment outcome includes improvement of signs and symptoms of CDAD, readmission due to CDAD recurrence, and fecal microbiota transplant (FMT) use after fidaxomicin treatment.
Results: Twenty-three patients who received total 30 courses of fidaxomicin with recurrent CDAD were evaluated. Three courses were determined to be inappropriate based on FACSH. All patients showed clinical improvement after starting fidaxomicin. Three patients have expired or were planned for hospice during the hospital encounter given the fidaxomicin course (13%). Out of 30 courses, 8 readmissions were noted to be readmissions due to CDAD recurrence after fidaxomicin courses (27%). Among 8 readmissions, 3 readmissions occurred within 30 days and 2 within 31-60 days. Six patients received FMT after fidaxomicin approval (26%). Of the 5 patients who received more than one course of fidaxomicin for CDAD at the Sinai, 3 received FMT (60%).
Conclusion: Ninety percent of fidaxomicin was approved appropriately based on FACSH. All patients reviewed showed symptomatic improvement after fidaxomicin administration. Twenty-seven percent of inpatient encounters were attributed to CDAD readmission after receipt of fidaxomicin course. Majority of patients who received more than 1 course of fidaxomicin ended up receiving FMT.
S. Lee, None
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