Benjamin Colwell, Jennifer Aguilar, Frances Hughes, Pavel Goriacko, Victor Chen, Mei Chang, Rachel Bartash, Yi Guo
{"title":"菲达霉素对艰难梭菌复发高风险患者的实际疗效。","authors":"Benjamin Colwell, Jennifer Aguilar, Frances Hughes, Pavel Goriacko, Victor Chen, Mei Chang, Rachel Bartash, Yi Guo","doi":"10.1017/ash.2024.381","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Compare the real-world impact of fidaxomicin (FDX) and vancomycin (VAN) on <i>Clostridioides difficile</i> infection (CDI) recurrence in a high-risk patient population.</p><p><strong>Design: </strong>A retrospective, matched-cohort study evaluating hospitalized patients with CDI from January 1, 2016, to November 1, 2022, within a tertiary academic medical center.</p><p><strong>Patients: </strong>Adult patients with at least 1 prior CDI case who received either FDX or VAN for non-fulminant CDI while admitted, and had at least 1 additional risk factor for recurrence. Risk factors included age >70, solid organ or bone marrow transplant recipients, broad-spectrum antibiotic use within 30 days, or receipt of chemotherapy/immune-modulating agents within 30 days of admission. FDX and VAN patients were matched according to risk factors.</p><p><strong>Results: </strong>A total of 415 patient admissions were identified. After the exclusion of 92 patients for fulminant CDI, diarrhea from another cause, or use of VAN taper therapy, and 15 unmatched patients, 308 patient admissions were included (68 FDX and 240 VAN patients). There were no significant differences in 4-week recurrence (26% vs 23%; OR 1.1; <i>P</i> = .51), 90-day CDI readmission (29% vs 23%; <i>P</i> = .65), or 90-day all-cause readmission (54% vs 53%; <i>P</i> = .91). There was a significant 17% decrease in 90-day mortality associated with the use of FDX (OR .3; <i>P</i> = .04).</p><p><strong>Conclusions: </strong>In a real-world high-risk patient population, the use of FDX compared to oral VAN did not result in decreased CDI recurrence within 4 weeks or fewer hospital readmissions within 90 days. Further research is needed to better assess the value of FDX in this patient population.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11406562/pdf/","citationCount":"0","resultStr":"{\"title\":\"Real-world effectiveness of fidaxomicin in patients at high risk of <i>Clostridioides difficile</i> recurrence.\",\"authors\":\"Benjamin Colwell, Jennifer Aguilar, Frances Hughes, Pavel Goriacko, Victor Chen, Mei Chang, Rachel Bartash, Yi Guo\",\"doi\":\"10.1017/ash.2024.381\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Compare the real-world impact of fidaxomicin (FDX) and vancomycin (VAN) on <i>Clostridioides difficile</i> infection (CDI) recurrence in a high-risk patient population.</p><p><strong>Design: </strong>A retrospective, matched-cohort study evaluating hospitalized patients with CDI from January 1, 2016, to November 1, 2022, within a tertiary academic medical center.</p><p><strong>Patients: </strong>Adult patients with at least 1 prior CDI case who received either FDX or VAN for non-fulminant CDI while admitted, and had at least 1 additional risk factor for recurrence. Risk factors included age >70, solid organ or bone marrow transplant recipients, broad-spectrum antibiotic use within 30 days, or receipt of chemotherapy/immune-modulating agents within 30 days of admission. FDX and VAN patients were matched according to risk factors.</p><p><strong>Results: </strong>A total of 415 patient admissions were identified. After the exclusion of 92 patients for fulminant CDI, diarrhea from another cause, or use of VAN taper therapy, and 15 unmatched patients, 308 patient admissions were included (68 FDX and 240 VAN patients). There were no significant differences in 4-week recurrence (26% vs 23%; OR 1.1; <i>P</i> = .51), 90-day CDI readmission (29% vs 23%; <i>P</i> = .65), or 90-day all-cause readmission (54% vs 53%; <i>P</i> = .91). There was a significant 17% decrease in 90-day mortality associated with the use of FDX (OR .3; <i>P</i> = .04).</p><p><strong>Conclusions: </strong>In a real-world high-risk patient population, the use of FDX compared to oral VAN did not result in decreased CDI recurrence within 4 weeks or fewer hospital readmissions within 90 days. Further research is needed to better assess the value of FDX in this patient population.</p>\",\"PeriodicalId\":72246,\"journal\":{\"name\":\"Antimicrobial stewardship & healthcare epidemiology : ASHE\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-09-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11406562/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Antimicrobial stewardship & healthcare epidemiology : ASHE\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1017/ash.2024.381\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Antimicrobial stewardship & healthcare epidemiology : ASHE","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1017/ash.2024.381","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
目的:比较菲达霉素(FDX)和万古霉素(VAN)对高危患者群体中艰难梭菌感染(CDI)复发的实际影响:比较菲达霉素(FDX)和万古霉素(VAN)对高风险患者群体中艰难梭菌感染(CDI)复发的实际影响:一项回顾性配对队列研究,评估一家三级学术医疗中心从2016年1月1日至2022年11月1日期间住院的CDI患者:既往至少有一例 CDI 病例的成人患者,入院时接受了 FDX 或 VAN 治疗非重症 CDI,且至少有一个额外的复发风险因素。风险因素包括年龄大于 70 岁、接受过实体器官或骨髓移植、30 天内使用过广谱抗生素或入院后 30 天内接受过化疗/免疫调节药物。根据风险因素对 FDX 和 VAN 患者进行配对:结果:共发现 415 例入院患者。在排除了92名因暴发性CDI、其他原因引起的腹泻或使用VAN减量疗法的患者和15名未配对的患者后,共纳入了308名入院患者(68名FDX患者和240名VAN患者)。4周复发率(26% vs 23%; OR 1.1; P = .51)、90天CDI再入院率(29% vs 23%; P = .65)或90天全因再入院率(54% vs 53%; P = .91)均无明显差异。使用 FDX 后,90 天死亡率大幅下降 17%(OR .3;P = .04):结论:在真实世界的高风险患者群体中,与口服 VAN 相比,使用 FDX 并不能降低 CDI 在 4 周内的复发率或 90 天内的再入院率。需要进一步研究以更好地评估 FDX 在这一患者群体中的价值。
Real-world effectiveness of fidaxomicin in patients at high risk of Clostridioides difficile recurrence.
Objective: Compare the real-world impact of fidaxomicin (FDX) and vancomycin (VAN) on Clostridioides difficile infection (CDI) recurrence in a high-risk patient population.
Design: A retrospective, matched-cohort study evaluating hospitalized patients with CDI from January 1, 2016, to November 1, 2022, within a tertiary academic medical center.
Patients: Adult patients with at least 1 prior CDI case who received either FDX or VAN for non-fulminant CDI while admitted, and had at least 1 additional risk factor for recurrence. Risk factors included age >70, solid organ or bone marrow transplant recipients, broad-spectrum antibiotic use within 30 days, or receipt of chemotherapy/immune-modulating agents within 30 days of admission. FDX and VAN patients were matched according to risk factors.
Results: A total of 415 patient admissions were identified. After the exclusion of 92 patients for fulminant CDI, diarrhea from another cause, or use of VAN taper therapy, and 15 unmatched patients, 308 patient admissions were included (68 FDX and 240 VAN patients). There were no significant differences in 4-week recurrence (26% vs 23%; OR 1.1; P = .51), 90-day CDI readmission (29% vs 23%; P = .65), or 90-day all-cause readmission (54% vs 53%; P = .91). There was a significant 17% decrease in 90-day mortality associated with the use of FDX (OR .3; P = .04).
Conclusions: In a real-world high-risk patient population, the use of FDX compared to oral VAN did not result in decreased CDI recurrence within 4 weeks or fewer hospital readmissions within 90 days. Further research is needed to better assess the value of FDX in this patient population.