Prohaska Laura, Mahmoudjafari Zahra, Shune Leyla, Singh Anurag, Lin Tara, Abhyankar Sunil, Ganguly Siddhartha, Grauer Dennis, McGuirk Joseph, Clough Lisa
Department of Pharmacy, University of Kansas Hospital, Kansas City, KS, USA.
Department of Pharmacy, University of Kansas Hospital, Kansas City, KS, USA.
Hematol Oncol Stem Cell Ther. 2018 Dec;11(4):233-240. doi: 10.1016/j.hemonc.2018.05.001. Epub 2018 Jun 18.
OBJECTIVE/BACKGROUND: Clostridium difficile infection (CDI) is a potential complication during hematopoietic stem cell transplantation (HSCT), and no specific recommendations exist regarding treatment of CDI in allogeneic SCT patients. Use of metronidazole and oral vancomycin has been associated with clinical failure. Fidaxomicin has previously been found noninferior to the use of oral vancomycin for the treatment of CDI, and no studies have compared the use of oral vancomycin with fidaxomicin for the treatment of CDI in allogeneic SCT.
This retrospective chart review included 96 allogeneic SCT recipients who developed CDI within 100 days following transplantation. Participants were treated with oral vancomycin (n = 52) or fidaxomicin (n = 44). The primary outcome was clinical cure, defined as no need for further retreatment 2 days following completion of initial CDI treatment. Secondary outcomes were global cure, treatment failure, and recurrent disease.
No differences in clinical cure were observed between patients receiving oral vancomycin or fidaxomicin (75% vs. 75%, p = 1.00). Secondary outcomes were similar between oral vancomycin and fidaxomicin in regards to global cure (66% vs. 67%, p = .508), treatment failure (28% vs. 27%, p = .571), and recurrent disease (7% vs. 5%, p = .747). In a subanalysis of individuals that developed acute graft-versus-host disease following CDI, the difference in mean onset of acute graft-versus-host disease was 21.03 days in the oral vancomycin group versus 32.88 days in the fidaxomicin group (p = .0031).
The findings of this study suggest that oral vancomycin and fidaxomicin are comparable options for CDI treatment in allogeneic SCT patients within 100 days following transplant.
目的/背景：艰难梭菌感染（CDI）是造血干细胞移植（HSCT）期间的一种潜在并发症，对于异基因造血干细胞移植（SCT）患者的CDI治疗尚无具体建议。甲硝唑和口服万古霉素的使用与临床治疗失败有关。先前已发现非达霉素在治疗CDI方面不劣于口服万古霉素，且尚无研究比较口服万古霉素与非达霉素治疗异基因SCT中CDI的疗效。
这项回顾性图表审查纳入了96名在移植后100天内发生CDI的异基因SCT受者。参与者接受口服万古霉素（n = 52）或非达霉素（n = 44）治疗。主要结局为临床治愈，定义为在初始CDI治疗完成后2天无需进一步再治疗。次要结局为整体治愈、治疗失败和疾病复发。
接受口服万古霉素或非达霉素治疗的患者在临床治愈方面未观察到差异（75%对75%，p = 1.00）。在整体治愈（66%对67%，p = 0.508）、治疗失败（28%对27%，p = 0.571）和疾病复发（7%对5%，p = 0.747）方面，口服万古霉素和非达霉素的次要结局相似。在CDI后发生急性移植物抗宿主病的个体亚分析中，口服万古霉素组急性移植物抗宿主病的平均发病时间与非达霉素组相比为21.03天对32.88天（p = 0.0031）。
本研究结果表明，口服万古霉素和非达霉素是移植后100天内异基因SCT患者CDI治疗的可比选择。
