title: Fidaxomicin versus conventional antimicrobial therapy in 59 recipients of solid organ and hematopoietic stem cell transplantation with Clostridium difficile-associated diarrhea.
abstract: The feasibility of fidaxomicin versus vancomycin and metronidazole (conventional therapy) was assessed in 59 transplant recipients with 61 episodes of Clostridium difficile-associated diarrhea (CDAD). Overall clinical cure was achieved in 86% of episodes, and in 7% of episodes, infection recurred. Fidaxomicin was well tolerated. Clinical cures were not significantly different compared with conventional therapy (67% versus 89%, respectively; P = 0.06). Univariate analysis of predictors for lack of clinical cure included continued use of broad-spectrum systemic antibiotics (P = 0.026) and prior diagnosis of CDAD (95% confidence interval, 1.113 to 19.569; odds ratio, 4.667; P = 0.041). New-onset vancomycin-resistant Enterococcus (VRE) colonization was not noted after fidaxomicin therapy alone. However, this occurred in 10 of 28 patients (36%) following conventional therapy, and 2 of 3 patients with subsequent bacteremia died.
authors.affiliation: New York University Langone Medical Center, New York University School of Medicine, New York, New York, USA.
authors.forename: Dana S
authors.initials: DS
authors.lastname: Clutter
authors.forename: Yanina
authors.initials: Y
authors.lastname: Dubrovskaya
authors.forename: Man Yee
authors.initials: MY
authors.lastname: Merl
authors.forename: Lewis
authors.initials: L
authors.lastname: Teperman
authors.forename: Robert
authors.initials: R
authors.lastname: Press
authors.forename: Amar
authors.initials: A
authors.lastname: Safdar
mesh_terms: D000328:Adult; D000368:Aged; D000617:Aminoglycosides / Q000627:therapeutic use*; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D016360:Clostridioides difficile / Q000187:drug effects* / Q000254:growth & development; D003967:Diarrhea / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D005260:Female; D000077732:Fidaxomicin; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D016377:Organ Transplantation; D016019:Survival Analysis; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use; D020713:Vancomycin Resistance
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D008795:Metronidazole; D014640:Vancomycin; D000077732:Fidaxomicin