Pettit Natasha N, Lew Alison K, Nguyen Cynthia T, Bell Elizabeth, Lehmann Christopher J, Pisano Jennifer
Department of Pharmacy, University of Chicago Medicine, Chicago, IL, USA.
Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, IL, USA.
Infect Control Hosp Epidemiol. 2024 Oct 4;45(11):1-7. doi: 10.1017/ice.2024.145.
infection (CDI) is a common nosocomial infection and is associated with a high healthcare burden due to high rates of recurrence. In 2021 the IDSA/SHEA guideline update recommended fidaxomicin (FDX) as first-line therapy. Our medical center updated our institutional guidelines to follow these recommendations, prioritizing FDX use among patients at high risk for recurrent CDI (rCDI).
This pre- post- quasi-experimental study included patients with a presumptive diagnosis of CDI at risk for recurrence (age >/= 65 years, immunocompromised, severe CDI) that received vancomycin (VAN) or FDX between October 2019 to October 2022. Patients who received bezlotoxumab, had fulminant CDI, or received <10 days of the same antibiotic for their full treatment course were excluded. Patients were evaluated for rCDI within 8 weeks of completion of therapy, subsequent episodes of CDI within 12 months, and CDI-related admissions within 30 days.
Of 397 CDI regimens evaluated, 196 received VAN and 201 received FDX. Rates of rCDI (9.2% vs 10%, = 0.86), subsequent CDI within 12 months of therapy completion of therapy (19.4% vs 26%, = 0.12) and 30-day CDI-related readmissions (3% vs 4.5%, = 0.6) were similar between patients who received VAN versus FDX.
Outcomes were similar between patients treated with FDX and VAN for the treatment of CDI among those at high risk for rCDI, using our outlined criteria. Although we observed a trend toward lower rates of rCDI among immunocompromised patients, this finding was not significant. Further investigation is needed to determine which patients with CDI may benefit from FDX.
艰难梭菌感染（CDI）是一种常见的医院感染，由于复发率高，其医疗负担也很高。2021年，美国感染病学会（IDSA）/美国医疗保健流行病学学会（SHEA）指南更新推荐非达霉素（FDX）作为一线治疗药物。我们的医疗中心更新了机构指南以遵循这些建议，优先在复发性CDI（rCDI）高危患者中使用FDX。
这项前后对照的准实验研究纳入了2019年10月至2022年10月期间接受万古霉素（VAN）或FDX治疗、有复发风险的疑似CDI患者（年龄≥65岁、免疫功能低下、严重CDI）。接受贝佐妥单抗治疗、暴发性CDI或整个治疗疗程使用同一种抗生素少于10天的患者被排除。在治疗完成后8周内评估患者的rCDI情况，治疗完成后12个月内评估后续CDI发作情况，30天内评估与CDI相关的住院情况。
在评估的397种CDI治疗方案中，196例接受了VAN治疗，201例接受了FDX治疗。接受VAN治疗与接受FDX治疗的患者之间，rCDI发生率（9.2%对10%，P = 0.86）、治疗完成后12个月内的后续CDI发生率（19.4%对26%，P = 0.12）以及30天内与CDI相关的再入院率（3%对4.5%，P = 0.6）相似。
根据我们制定的标准，在rCDI高危患者中，使用FDX和VAN治疗CDI的患者结局相似。虽然我们观察到免疫功能低下患者的rCDI发生率有降低趋势，但这一发现并不显著。需要进一步研究以确定哪些CDI患者可能从FDX治疗中获益。
