Work

Fidaxomicin for Initial Episode of Clostridioides difficile Infection Reduces Recurrence in Immunocompromised Hosts—a Large Retrospective Cohort Study

Year: 2025

Type: article

Abstract: Introduction Fidaxomicin is a narrow-spectrum, nonabsorbable antibiotic recommended as first-line therapy for nonfulminant Clostridioides difficile infection (CDI). While some studies suggest a reduction of recurrence for immunocompromised hosts (ICHs), the findings remain inconsistent and limited. We aimed to evaluate the clinical outcomes of fidaxomicin for a first CDI episode in ICHs within a large healthcare system. Methods We conducted a retrospective cohort study of Clalit Health Services adults with a first laboratory-confirmed CDI between January 2013 and December 2023. Patients with prior CDI were excluded. The primary outcome was a composite of recurrence, 90-day mortality, and colectomy, which were compared between the fidaxomicin and vancomycin groups. Secondary outcomes included each component individually. Results The study included 11 204 patients with a first CDI episode, of whom 2362 were immunocompromised. The fidaxomicin group had a significantly lower recurrence rate compared to vancomycin (8% vs 17%, P = .019), while it was not associated with reduced composite outcome (aOR = .65, 95% CI .39–1.07, P = .09). Multivariable analysis also confirmed a reduction in recurrence risk (aOR 0.44, 95% CI .21–.96). Older age, previous antibiotic use within 90 days, and hypoalbuminemia were independently associated with worse outcomes, while recurrence was linked to increased long-term mortality. Conclusions ICHs treated with fidaxomicin had significantly lower recurrence rates and fewer complications compared to vancomycin. Despite assumptions, ICHs had recurrence rates similar to immunocompetent patients, highlighting the role of comorbidities and treatment choices. Our findings support fidaxomicin as a preferred first-line option in select ICHs and underscore the need for individualized management strategies to improve outcomes in this high-risk population.

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofaf751

Authors: Alaa Atamna, Adi Turjeman, Genady Drozdinsky, Haim Ben Zvi, Tzippy Shochat, Jihad Bishara

Institutions: Tel Aviv University, Rabin Medical Center

Language: English

Topic: Clostridium difficile and Clostridium perfringens research

Subfield: Infectious Diseases

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $4,053