Methods: Prospective observational study in an 1100 bed academic community health system. Patient enrollment between 4/2013 and 4/2014 included hospitalized patients >18 years, having a first episode CDAD, > 3 stools/24 hours and a positive stool assay . Patients were excluded if there were barriers to follow up or anticipated <6-month survival. Telephone interviews were conducted weekly then monthly for 1 year to determine CDAD activity, wellness, and attitudes.
Results: 158 patients were enrolled, and 113 were followed for a full 12 months. The all- cause mortality was 16%. Initial treatment included vancomycin (V) 19%, metronidazole (M) 55%, and combination (VM) 24%. Rifaximin or fidaxomicin were used for only 2% of patients. Treatment with combination therapy was more common in moderate/severe disease than mild disease (28% vs. 13%). 43% of patients received probiotics at some point in care. Primary relapse rate was 20% (23/113), and of those, 22% (5/23) patients had a second relapse (overall 4%). Attitudes toward FMT were assessed in 92 of the 158 enrolled patients, and 52% (48/92) of patients would accept FMT if offered.
Conclusion: The use of combination vancomycin/metronidazole is high and increasingly used in the severe CDAD patient. Our primary relapse rate of 20% appears to fit prior studies; however, our secondary relapse rate of 22%(4% overall) is lower than expected. 4% of our CDAD population are candidates for FMT based on strict hospital criteria (2 relapses). A high percentage of CDAD patients (52%) would accept FMT as treatment if offered.
A. E. Bacon III,
C. Jurkovitz, None
B. Ingraham Lopresto, None
M. Drees, None
A. Panwalker, None
P. Mcgraw, None
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