Fidaxomicin, a poorly absorbed macrocyclic antibiotic, was shown to be as effective as oral vancomycin in the treatment of Clostridium difficile infections (CDI) and to lower recurrence rates in infections with non-North American Pulsed-field gel electrophoresis type 1 strains (NAP1). We aimed to determine clinical recurrence and cure rates of CDI treated with fidaxomicin.
Patients who received fidaxomicin therapy as an inpatient at Stony Brook University Hospital were identified through pharmacy records. Chart review was performed in all patients who received fidaxomicin from August 2011 to November 2015. Clinical recurrence was defined by the reappearance of diarrhea with a positive test for C. difficile toxin B gene and a need for retreatment for CDI within 90 days of cessation of therapy.
We identified 72 patients who received fidaxomicin during a 50-month period. Seventeen patients were excluded because they received less than 10 days of fidaxomicin. Final analysis included 55 patients (median age: 64 years old; range 24-90; 29 men and 26 women). Out of 55, 34 (62%) had a known history of prior CDI, only 6 patients received a fidaxomicin based regimen as initial therapy choice, with the average being 6.4 days of treatment with oral vancomycin and/or metronidazole prior to switching. The final regimen was fidaxomicin alone in 34 (62%) or combination therapy with oral vancomycin or metronidazole in 21 (38%). A total of 22 patients had clinical recurrence of CDI (40%). In those with recurrent CDI, the median time of fidaxomicin therapy was 14 days whereas in those without recurrence was 12 days (p=0.4). The overall prevalence of the NAP1/B1/027 strain was 36.4% (40.9% in recurrent group vs. 33.3% in non-recurrent group; p=0.5). All cause mortality at 90 days was higher in the recurrent (18.2%) than non-recurrent group (6.1%) (p=0.1). In a univariate analysis, having chronic kidney disease (CKD) was associated with recurrent CDI (OR=6.9, 95%CI:1.61-29.8; p=0.009).
We found a relatively high rate of recurrence CDI (40%) in patients who received fidaxomicin therapy in this study. Patients with CKD may be at higher risk of recurrence for CDI.
E. Spitzer, None
L. F. Ottaviano, None
A. Phoenix, None
C. Antoine, None
A. Khan, None
L. A. Marcos, None