Spiceland Clayton M, Khanna Sahil, Pardi Darrell S
Department of Internal Medicine.
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN.
J Clin Gastroenterol. 2018 Feb;52(2):151-154. doi: 10.1097/MCG.0000000000000769.
Fidaxomicin is a new antibiotic used to treat Clostridium difficile infection (CDI). Given limited clinical experience with fidaxomicin, we assessed outcomes in a diverse cohort of patients with CDI treated with fidaxomicin.
All CDI cases treated with fidaxomicin at 3 referral centers over a 4-year period were included. Response was defined as resolution of diarrhea and recurrence was defined by recurrence of CDI within 8 weeks of the end of treatment.
Overall, 81 patients (median age 55.9 y; 53% female; 26% with inflammatory bowel disease) were included. Response occurred in 90%. Responders had fewer prior CDI episodes [median 1 (range, 0 to 8)] than nonresponders [median 2.5 (range, 1 to 8)], P=0.01. Response after a first CDI episode was 100%, 96% after 1 prior episode, and 82% after 2 or more, P=0.02. Recurrence occurred in 19%. Patients without recurrence had fewer prior episodes of CDI [median 1 (range, 0 to 6)] than patients who recurred [median 2 (range, 1 to 8)], P=0.005. Recurrence after a first episode was 0%, 23% after 1 prior episode, and 29% after 2 or more, P=0.005. All patients with inflammatory bowel disease responded either with improvement of symptoms or a negative C. difficile test; 19% recurred.
All patients with a first CDI episode treated with fidaxomicin responded with no recurrences. Patients with prior CDI episodes were less likely to respond (especially with more than 1 prior episode) and more likely to recur, suggesting a greater clinical benefit of fidaxomicin earlier in the course of CDI.
非达霉素是一种用于治疗艰难梭菌感染（CDI）的新型抗生素。鉴于非达霉素的临床经验有限，我们评估了接受非达霉素治疗的不同CDI患者队列的治疗结果。
纳入了4年间在3个转诊中心接受非达霉素治疗的所有CDI病例。缓解定义为腹泻症状消失，复发定义为治疗结束后8周内CDI复发。
总共纳入了81例患者（中位年龄55.9岁；53%为女性；26%患有炎症性肠病）。90%的患者症状得到缓解。缓解者之前的CDI发作次数[中位数1次（范围0至8次）]少于未缓解者[中位数2.5次（范围1至8次）]，P=0.01。首次CDI发作后的缓解率为100%，有1次既往发作后的缓解率为96%，有2次或更多次既往发作后的缓解率为82%，P=0.02。19%的患者出现复发。无复发患者之前的CDI发作次数[中位数1次（范围0至6次）]少于复发患者[中位数2次（范围1至8次）]，P=0.005。首次发作后的复发率为0%，有1次既往发作后的复发率为23%，有2次或更多次既往发作后的复发率为29%，P=0.005。所有患有炎症性肠病的患者症状均有改善或艰难梭菌检测呈阴性；19%的患者复发。
接受非达霉素治疗的所有首次CDI发作患者均获缓解且无复发。有既往CDI发作史的患者缓解的可能性较小（尤其是有1次以上既往发作史者）且复发可能性更大，这表明在CDI病程早期使用非达霉素具有更大的临床益处。
