Real-life experience with fidaxomicin in Clostridioides difficile infection: a multicentre cohort study on 244 episodes.

Data de publicació: 01/06/2021 Data Ahead of Print: 08/01/2021

Autors de IIS La Fe

Sandra Cuéllar Tovar

Autor
Miguel Salavert Lletí

Autor
Iván Castro Hernández

Autor

Autors aliens a IIS La Fe

Escudero-Sánchez R
Valencia-Alijo A
Merino-de Lucas E
García Fernández S
Gutiérrez-Rojas Á
Ramos-Martínez A
Giner L
Cobo J

Grups d'Investigació

Infección Grave

Investigador Principal

María Ángeles Tormo Mas

Abstract

The high cost of fidaxomicin has restricted its use despite the benefit of a lower Clostridioides difficile infection (CDI) recurrence rate at 4 weeks of follow-up. This short follow-up represents the main limitation of pivotal clinical trials of fidaxomicin, and some recent studies question its benefits over vancomycin. Moreover, the main risk factors of recurrence after treatment with fidaxomicin remain unknown. We designed a multicentre retrospective cohort study among four Spanish hospitals to assess the efficacy of fidaxomicin in real life and to investigate risk factors of fidaxomicin failure at weeks 8 and 12. Two-hundred forty-four patients were included. Fidaxomicin was used in 96 patients (39.3%) for a first episode of CDI, in 95 patients (38.9%) for a second episode, and in 53 patients (21.7%) for a third or subsequent episode. Patients treated with fidaxomicin in a first episode were younger (59.9 years vs 73.5 years), but they had more severe episodes (52.1% vs. 32.4%). The recurrence rates for patients treated in the first episode were 6.5% and 9.7% at weeks 8 and 12, respectively. Recurrence rates increased for patients treated at second or ulterior episodes (16.3% and 26.4% at week 8, respectively). Age greater than or equal to 85 years and having had a previous episode of CDI were identified as recurrence risk factors at weeks 8 and 12. We conclude that the outcomes with fidaxomicin in real life are at least as good as those observed in clinical trials despite a more demanding evaluation. Be it 85 years of age or older, and the use after a first episode appears to be independent factors of CDI recurrence after treatment with fidaxomicin.

Dades de la publicació

ISSN/ISSNe:: 0300-8126, 1439-0973
Tipus:: Article
Pàgines:: 475-482
DOI:: 10.1007/s15010-020-01567-5
PubMed:: 33417171
Factor d'Impacte:: 1,119 SCImago ℠
Quartil:: Q1 SCImago ℠

Documents

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Mètriques

Filiacions

Escudero-Sánchez R:: Infectious Disease Department, University Hospital Ramon Y Cajal, Ctra. Colmenar Viejo, Km 9,1. Zip code 28034, Madrid, Spain.

Spanish Network for Research in Infectious Disease (REIPI), Madrid, Spain.
Valencia-Alijo A:: Internal Medicine Department, University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
Cuéllar Tovar S:: Internal Medicine Department, University Hospital La Fe, Valencia, Spain
Merino-de Lucas E:: Internal Medicine Department, University Hospital General de Alicante, Alicante, Spain
García Fernández S:: Spanish Network for Research in Infectious Disease (REIPI), Madrid, Spain

Microbiology Department, University Hospital Ramon y Cajal, Madrid, Spain
Gutiérrez-Rojas Á:: Internal Medicine Department, University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
Ramos-Martínez A:: Internal Medicine Department, University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
Salavert Lletí M:: Internal Medicine Department, University Hospital La Fe, Valencia, Spain
Castro Hernández I:: Internal Medicine Department, University Hospital La Fe, Valencia, Spain
Giner L:: Internal Medicine Department, University Hospital General de Alicante, Alicante, Spain
Cobo J:: Infectious Disease Department, University Hospital Ramon Y Cajal, Ctra. Colmenar Viejo, Km 9,1. Zip code 28034, Madrid, Spain

Spanish Network for Research in Infectious Disease (REIPI), Madrid, Spain