Microbiological Characterization and Clinical Outcomes After Extended-Pulsed Fidaxomicin Treatment for Clostridioides difficile Infection in the EXTEND Study.

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Version: Final published version
License: CC BY-NC-ND 4.0
Serval ID
serval:BIB_49A5FCFA8072
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Microbiological Characterization and Clinical Outcomes After Extended-Pulsed Fidaxomicin Treatment for Clostridioides difficile Infection in the EXTEND Study.
Journal
Open forum infectious diseases
Author(s)
Wilcox M.H., Cornely O.A., Guery B., Longshaw C., Georgopali A., Karas A., Kazeem G., Palacios-Fabrega J.A., Vehreschild MJGT
ISSN
2328-8957 (Print)
ISSN-L
2328-8957
Publication state
Published
Issued date
11/2019
Peer-reviewed
Oui
Volume
6
Number
11
Pages
ofz436
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
Clostridioides (Clostridium) difficile infection (CDI) is diagnosed using clinical signs and symptoms plus positive laboratory tests. Recurrence of CDI after treatment is common, and coinfection with other enteric pathogens may influence clinical outcomes.
We aimed to assess rates of C difficile positivity, by enzyme-linked immunosorbent assay (ELISA) toxin A/B and BioFire FilmArray, and the effect of enteric coinfection on clinical outcomes, using samples from the EXTEND study of extended-pulsed fidaxomicin (EPFX) versus standard vancomycin.
All 356 randomized and treated patients tested positive for C difficile toxin A/B by local tests; a majority (225 of 356, 63.2%) also tested positive by both ELISA and BioFire. Most stool samples taken at screening tested positive for C difficile only using BioFire (EPFX: 112 of 165, 69.7%; vancomycin: 118 of 162, 72.8%). Of the 5 patients who failed treatment and had stool samples available, all (1) had tested negative for C difficile by BioFire at screening and (2) were negative by ELISA at time of treatment failure. When analyzed by BioFire results at screening, rates of sustained clinical cure at 30 days after end of treatment were numerically higher with EPFX than with vancomycin for almost all patients, except for those who tested negative for C difficile but positive for another pathogen. However, these outcome differences by presence of coinfection did not reach statistical significance. Whole-genome sequencing analysis determined that 20 of 26 paired samples from patients with recurrence were reinfections with the same C difficile strain.
Testing for presence of copathogens in clinical trials of antibiotics could help to explain clinical failures.
Keywords
Clostridioides difficile, fidaxomicin, gut microbiota, infection, vancomycin
Pubmed
Web of science
Open Access
Yes
Create date
29/11/2019 21:24
Last modification date
15/01/2021 7:09
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