Fidaxomicin for treatment of clostridium ...
Document type :
Article dans une revue scientifique: Article original
PMID :
Permalink :
Title :
Fidaxomicin for treatment of clostridium difficile infection in clinical practice: a prospective cohort study in a french university hospital
Author(s) :
Pichenot, Marie [Auteur]
Université de Lille
Hequette-Ruz, Rozenn [Auteur]
Université de Lille
Le Guern, Rémi [Auteur]
Recherche translationelle relations hôte-pathogènes
Recherche translationnelle : relations hôte-pathogènes - EA 7366
Grandbastien, Bruno [Auteur]
Université de Lille
Charlet, Clement [Auteur]
Université de Lille
Wallet, Frederic [Auteur]
Centre d’Infection et d’Immunité de Lille - INSERM U 1019 - UMR 9017 - UMR 8204 [CIIL]
Schiettecatte, Sophie [Auteur]
Université de Lille
Loeuillet, Fanny [Auteur]
Université de Lille
Guery, Benoit [Auteur]
Université de Lille
Galperine, Tatiana [Auteur]
Université de Lille
Université de Lille
Hequette-Ruz, Rozenn [Auteur]
Université de Lille
Le Guern, Rémi [Auteur]

Recherche translationelle relations hôte-pathogènes
Recherche translationnelle : relations hôte-pathogènes - EA 7366
Grandbastien, Bruno [Auteur]
Université de Lille
Charlet, Clement [Auteur]
Université de Lille
Wallet, Frederic [Auteur]

Centre d’Infection et d’Immunité de Lille - INSERM U 1019 - UMR 9017 - UMR 8204 [CIIL]
Schiettecatte, Sophie [Auteur]
Université de Lille
Loeuillet, Fanny [Auteur]
Université de Lille
Guery, Benoit [Auteur]
Université de Lille
Galperine, Tatiana [Auteur]
Université de Lille
Journal title :
Infection
Abbreviated title :
Infection
Volume number :
45
Pages :
425-431
Publication date :
2017-08-01
ISSN :
0300-8126
English keyword(s) :
Fidaxomicin
Clinical practice
Prospective
Clostridium difficile
Mesh:Aged
Mesh:Aminoglycosides/therapeutic use*
Mesh:Anti-Bacterial Agents/therapeutic use*
Mesh:Clostridium Infections/drug therapy*
Mesh:Clostridium difficile/drug effects
Mesh:Female
Mesh:France
Mesh:Hospitals
Mesh:University
Mesh:Humans
Mesh:Male
Mesh:Middle Aged
Mesh:Prospective Studies
Clinical practice
Prospective
Clostridium difficile
Mesh:Aged
Mesh:Aminoglycosides/therapeutic use*
Mesh:Anti-Bacterial Agents/therapeutic use*
Mesh:Clostridium Infections/drug therapy*
Mesh:Clostridium difficile/drug effects
Mesh:Female
Mesh:France
Mesh:Hospitals
Mesh:University
Mesh:Humans
Mesh:Male
Mesh:Middle Aged
Mesh:Prospective Studies
HAL domain(s) :
Sciences du Vivant [q-bio]
English abstract : [en]
OBJECTIVE: Two randomized controlled trials (RCTs) showed the non-inferiority of fidaxomicin compared with vancomycin for Clostridium difficile infection (CDI) treatment and its superiority regarding recurrence rate. The ...
Show more >OBJECTIVE: Two randomized controlled trials (RCTs) showed the non-inferiority of fidaxomicin compared with vancomycin for Clostridium difficile infection (CDI) treatment and its superiority regarding recurrence rate. The aim of this study was to evaluate fidaxomicin's efficacy in clinical practice. METHODS: This single-center prospective cohort study included hospitalized patients treated with fidaxomicin for CDI. Demographic, clinical and biological data were collected. Primary outcome was efficacy of fidaxomicin (clinical cure, recurrence and global cure) at 10 weeks. Secondary outcome was efficacy among different subgroups. RESULTS: Ninety-nine patients were included: 42 severe CDI, 16 complicated CDI and 41 recurrent CDI. Rates of clinical cure, recurrence and global cure were 87, 15 and 59%, respectively. Subgroup analysis showed a higher recurrence rate for patients with recurrent CDI compared with first episode (8 vs. 26%; p = 0.04). Binary toxin was associated with severe/complicated CDI (80 vs. 50%; p < 0.01) and recurrence (32 vs. 7%; p < 0.01). Fidaxomicin was used as a first line for 83% of the patients with recurrence and for only 52% of first episodes even though 86% had recurrence's risk factors. CONCLUSIONS: Compared with RCTs, fidaxomicin in real world is used for patients with more severe and recurrent CDI, but clinical cure and recurrence rates were similar. Comparative studies are needed in these specific subgroups. Our data also illustrate clinicians' difficulty to define a "patient at risk for recurrence" among the first episodes. Finally, we showed that binary toxin could be important in the screening for severity and recurrence risks.Show less >
Show more >OBJECTIVE: Two randomized controlled trials (RCTs) showed the non-inferiority of fidaxomicin compared with vancomycin for Clostridium difficile infection (CDI) treatment and its superiority regarding recurrence rate. The aim of this study was to evaluate fidaxomicin's efficacy in clinical practice. METHODS: This single-center prospective cohort study included hospitalized patients treated with fidaxomicin for CDI. Demographic, clinical and biological data were collected. Primary outcome was efficacy of fidaxomicin (clinical cure, recurrence and global cure) at 10 weeks. Secondary outcome was efficacy among different subgroups. RESULTS: Ninety-nine patients were included: 42 severe CDI, 16 complicated CDI and 41 recurrent CDI. Rates of clinical cure, recurrence and global cure were 87, 15 and 59%, respectively. Subgroup analysis showed a higher recurrence rate for patients with recurrent CDI compared with first episode (8 vs. 26%; p = 0.04). Binary toxin was associated with severe/complicated CDI (80 vs. 50%; p < 0.01) and recurrence (32 vs. 7%; p < 0.01). Fidaxomicin was used as a first line for 83% of the patients with recurrence and for only 52% of first episodes even though 86% had recurrence's risk factors. CONCLUSIONS: Compared with RCTs, fidaxomicin in real world is used for patients with more severe and recurrent CDI, but clinical cure and recurrence rates were similar. Comparative studies are needed in these specific subgroups. Our data also illustrate clinicians' difficulty to define a "patient at risk for recurrence" among the first episodes. Finally, we showed that binary toxin could be important in the screening for severity and recurrence risks.Show less >
Language :
Anglais
Audience :
Internationale
Popular science :
Non
Administrative institution(s) :
CHU Lille
CNRS
Inserm
Institut Pasteur de Lille
Université de Lille
CNRS
Inserm
Institut Pasteur de Lille
Université de Lille
Collections :
Submission date :
2020-02-11T09:07:29Z
2020-04-30T08:12:34Z
2020-04-30T08:12:34Z
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