501. Evaluation of Bezlotoxumab in Prevention of Recurrent C. difficile Infection: A Multicenter Single Arm Study in Outpatient Infusion Centers
Session: Poster Abstract Session: Healthcare Epidemiology: Updates in C. difficile
Thursday, October 4, 2018
Room: S Poster Hall
  • IDWeek 2018_Hengel et al_501_Bezlotoxumab in Prevention of rCDI.pdf (412.1 kB)
  • BackgroundBezlotoxumab (BEZ) was approved in October 2016 for the prevention of recurrent C. difficile (rCDI) infection in patients (pts) receiving standard-of-care (SoC) antibiotic therapy for active CDI who are at high risk for CDI recurrence. Presently, there are little real-world data on recurrence rates and factors associated with recurrence in pts receiving BEZ. This study describes characteristics of pts receiving BEZ in US outpatient infusion centers (OICs) and analyzes subsequent CDI recurrences.

    MethodsMedical records from 24 OICs were retrospectively reviewed of all pts treated with BEZ through December 2017. Data collected included demographics, comorbidities, and all therapy parameters, including SoC antibiotic therapy. Risk factors for rCDI were assessed and included age, immunocompromised status, prior number of CDI episodes, use of gastric acid suppressants, inflammatory bowel disease (IBD) and history of fecal microbiota transplant (FMT).  rCDI, defined as diarrhea lasting ≥2 days with treatment for CDI with or without a positive stool test for toxigenic C. difficile, was assessed through a follow-up visit or phone call 90 days post BEZ administration. Risk factors for rCDI were evaluated using Student’s t test and Pearson Chi square test.

    ResultsEighty pts received BEZ (10 mg/kg) with 78 available for follow-up evaluation for rCDI ≥90 days post treatment.  Mean age was 65±16 years with 51% female.  Mean number of CDI episodes were 3±1 with a mean Charlson score of 4±3. SoC antibiotics included vancomycin (66% of pts) with 41% on long term taper, fidaxomicin (33% of pts), and metronidazole (25% of pts). Nineteen (24%) patients received more than one SoC antibiotic during their treatment course, most commonly with metronidazole and another SoC antibiotic.  Of the 78 pts with follow-up data, 17 (22%) developed rCDI with a mean time to recurrence of 33±22 days. Risk factors for rCDI are shown in the table. Use of BEZ earlier in the disease course (1st or 2nd CDI episode) was associated with a decreased risk of rCDI (OR: 0.21 95% CI: 0.04-0.98; p=0.033). 

    Conclusion: In highly comorbid patients with recurrent Clostridium difficile infection, bezlotoxumab use was effective in prevention of recurrence at 90 days and consistent with that of the randomized trials. 


    Richard L. Hengel, MD1, Timothy E. Ritter, MD2, Ramesh V. Nathan, MD, FIDSA3, Lucinda J. Van Anglen, PharmD4, Claudia P. Schroeder, PharmD, PhD4, Stephen Marcella, MD, MPH5 and Kevin W. Garey, PharmD, M.S.6, (1)Atlanta ID Group, Atlanta, GA, (2)Luminal Research Division, Texas Digestive Disease Consultants, Southlake, TX, (3)Mazur, Statner, Dutta, Nathan, PC, Thousand Oaks, CA, (4)Healix Infusion Therapy, Sugar Land, TX, (5)Center for Observational and Real World Evidence, Merck & Co., Inc., Kenilworth, NJ, (6)Pptr, University of Houston College of Pharmacy, Houston, TX


    R. L. Hengel, Merck & Co.: Scientific Advisor , Consulting fee .

    T. E. Ritter, Merck & Co.: Scientific Advisor , Consulting fee .

    R. V. Nathan, Merck & Co.: Scientific Advisor and Speaker's Bureau , Consulting fee and Speaker honorarium . The Medicines Company: Speaker's Bureau , Speaker honorarium . Allergan: Speaker's Bureau , Speaker honorarium .

    L. J. Van Anglen, Merck & Co.: Grant Investigator , Research grant .

    C. P. Schroeder, None

    S. Marcella, Merck & Co.: Employee and Shareholder , Salary .

    K. W. Garey, Merck & Co.: Grant Investigator , Grant recipient .

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.