Fidaxomicin for treatment of Clostridium difficile infection in clinical practice: a prospective cohort study in a French University Hospital.

Details

Serval ID
serval:BIB_4F4DFAB1200E
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Fidaxomicin for treatment of Clostridium difficile infection in clinical practice: a prospective cohort study in a French University Hospital.
Journal
Infection
Author(s)
Pichenot M., Héquette-Ruz R., Le Guern R., Grandbastien B., Charlet C., Wallet F., Schiettecatte S., Loeuillet F., Guery B., Galperine T.
ISSN
1439-0973 (Electronic)
ISSN-L
0300-8126
Publication state
Published
Issued date
08/2017
Peer-reviewed
Oui
Volume
45
Number
4
Pages
425-431
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Two randomized controlled trials (RCTs) showed the non-inferiority of fidaxomicin compared with vancomycin for Clostridium difficile infection (CDI) treatment and its superiority regarding recurrence rate. The aim of this study was to evaluate fidaxomicin's efficacy in clinical practice.
This single-center prospective cohort study included hospitalized patients treated with fidaxomicin for CDI. Demographic, clinical and biological data were collected. Primary outcome was efficacy of fidaxomicin (clinical cure, recurrence and global cure) at 10 weeks. Secondary outcome was efficacy among different subgroups.
Ninety-nine patients were included: 42 severe CDI, 16 complicated CDI and 41 recurrent CDI. Rates of clinical cure, recurrence and global cure were 87, 15 and 59%, respectively. Subgroup analysis showed a higher recurrence rate for patients with recurrent CDI compared with first episode (8 vs. 26%; p = 0.04). Binary toxin was associated with severe/complicated CDI (80 vs. 50%; p < 0.01) and recurrence (32 vs. 7%; p < 0.01). Fidaxomicin was used as a first line for 83% of the patients with recurrence and for only 52% of first episodes even though 86% had recurrence's risk factors.
Compared with RCTs, fidaxomicin in real world is used for patients with more severe and recurrent CDI, but clinical cure and recurrence rates were similar. Comparative studies are needed in these specific subgroups. Our data also illustrate clinicians' difficulty to define a "patient at risk for recurrence" among the first episodes. Finally, we showed that binary toxin could be important in the screening for severity and recurrence risks.

Keywords
Aged, Aminoglycosides/therapeutic use, Anti-Bacterial Agents/therapeutic use, Clostridium Infections/drug therapy, Clostridium difficile/drug effects, Female, France, Hospitals, University, Humans, Male, Middle Aged, Prospective Studies, Clinical practice, Clostridium difficile, Fidaxomicin, Prospective
Pubmed
Web of science
Create date
30/01/2017 19:31
Last modification date
20/08/2019 15:05
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