title: A multi-center study of fidaxomicin use for Clostridium difficile infection.
abstract: OBJECTIVE
  Fidaxomicin use in real-world clinical practice, especially for severe Clostridium difficile infection (CDI), is mainly based on single-center observational studies. The purpose of this pharmacoepidemiology study was to assess outcomes of patients given fidaxomicin based on episode number and use of concomitant antibiotics.
  
  
  METHODS
  Fidaxomicin use over time across included hospitals in the United States was assessed using a large inpatient drug utilization database. A multicenter retrospective chart review was also conducted of hospitalized patients with CDI that received fidaxomicin between 2011 and 2013. Fidaxomicin utilization and clinical outcomes were stratified by use of fidaxomicin for first or second episode (early episodes) versus greater than or equal to episodes (later episodes).
  
  
  RESULTS
  The overall fidaxomicin use rate was 2.16 % which increased from 0.22 % in the last two quarters of 2011 to 3.16 % in the first two quarters of 2013. A total of 102 hospitalized patients that received fidaxomicin from 11 hospitals were identified in the multicenter study. Sixty-nine patients received fidaxomicin for early (68 % with severe CDI) and 33 received for later episodes. The majority of patients received other CDI therapy including 61 patients (88 %) for early episodes and 27 (82 %) for later episodes. Concomitant non-CDI antibiotics were received by 48 patients (47 %). Rates of clinical outcomes were similar regardless of CDI episode.
  
  
  CONCLUSIONS
  This study demonstrated a slow but steady increase in fidaxomicin utilization over time; most of which was combined with other systemic antibiotics. Antimicrobial stewardship teams should provide guidance on appropriate use of fidaxomicin to optimize therapy and assess the need to continue other antibiotics during CDI treatment.
authors.affiliation: Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, 1441 Moursund Street, Houston, TX 77030 USA.
authors.forename: Dhara N
authors.initials: DN
authors.lastname: Shah
authors.affiliation: Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, 1441 Moursund Street, Houston, TX 77030 USA.
authors.forename: Fay S
authors.initials: FS
authors.lastname: Chan
authors.affiliation: Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX USA.
authors.forename: Nandita
authors.initials: N
authors.lastname: Kachru
authors.affiliation: Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, 1441 Moursund Street, Houston, TX 77030 USA.
authors.forename: Krutina P
authors.initials: KP
authors.lastname: Garcia
authors.affiliation: Department of Pharmacy, Roper St Francis Healthcare System, Charleston, SC USA.
authors.forename: Holly E
authors.initials: HE
authors.lastname: Balcer
authors.affiliation: Department of Pharmacy, Southeastern Health, Lumberton, NC USA.
authors.forename: April P
authors.initials: AP
authors.lastname: Dyer
authors.affiliation: Department of Pharmacy, OhioHealth MedCentral Hospitals, Mansfield, OH USA.
authors.forename: John E
authors.initials: JE
authors.lastname: Emanuel
authors.affiliation: Department of Pharmacy, Vidant Medical Center, Greenville, NC USA.
authors.forename: Michelle D
authors.initials: MD
authors.lastname: Jordan
authors.affiliation: Department of Pharmacy, UAMS Medical Center, Little Rock, AR USA.
authors.forename: Katherine T
authors.initials: KT
authors.lastname: Lusardi
authors.affiliation: Department of Pharmacy, St. Mary's Hospital, Madison, WI USA.
authors.forename: Geri
authors.initials: G
authors.lastname: Naymick
authors.affiliation: Department of Pharmacy, Northwestern Medicine Central DuPage Hospital, Winfield, IL USA.
authors.forename: Radhika S
authors.initials: RS
authors.lastname: Polisetty
authors.affiliation: Department of Pharmacy, North Kansas City Hospital, North Kansas, MO USA.
authors.forename: Lanny
authors.initials: L
authors.lastname: Sieman
authors.affiliation: Department of Pharmacy, Saint Thomas Midtown Hospital, Nashville, TN USA.
authors.forename: Ashley M
authors.initials: AM
authors.lastname: Tyler
authors.affiliation: Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX USA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Johnson
authors.affiliation: Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, 1441 Moursund Street, Houston, TX 77030 USA.
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Garey
keywords: Anaerobe infections; Clinical practice; Pharmacoepidemiology; Real-world study; Treatment