Comparison of Fidaxomicin and Vancomycin for Recurrent Clostridium difficile Colitis

Abstract

BackgroundFidaxomicin is a narrow spectrum macrocyclic antibiotic used for the treatment of Clostridium difficileinfection (CDI). The objective of this study is to compare the recurrence and mortality rates of patients with CDI who received either vancomycin or fidaxomicin at Stony Brook University Hospital.MethodsA retrospective chart review was performed to identify all hospitalized patients who received fidaxomicin and vancomycin for CDI for the period 2011–2015. Inclusion criteria included patient age ≥18 years, stool positive PCR test for C. difficile and being treated ≥10 days of either fidaxomicin or vancomycin orally. Clinical recurrence was defined as a return of diarrhea, a positive test for C. difficiletoxin B and a need for retreatment for CDI within 90 days of cessation of therapy.ResultsA total of 55 (52.7% male) and 74 (51.4% male) cases met inclusion criteria in the fidaxomicin (F) and vancomycin (V) groups, respectively. The mean age was 65.9 ± 1.88 and 63.7 ± 1.86 years in group F and V respectively (P = 0.4). Median length of hospitalization was 14 and 9 days for F and V respectively (P = 0.6). Both groups had similar proportions on the following variables: immunosuppression (V 36.5% vs. F 36.4%; P = 0.9), ≥ 1 prior episode of CDI (V 59.5% vs. F 61.8%; P = 0.8), sepsis on admission (V 29.7%, F 36.4%; P = 0.4), the use of any antibiotic during the last 30 days (V 74.3%, 71%, P = 0.7), and treatment with additional anti-CDI therapy (V 24.3%, F 29.1%; P = 0.5). CDI recurrence rate was 24% (V) and 40% (F, P = 0.057). The 90-day mortality rate was 4.1% in the vancomycin group and 10.9% in the fidaxomicin group (P = 0.13).ConclusionFidaxomicin had a higher recurrent CDI than vancomycin in this tertiary medical center.Disclosures All authors: No reported disclosures.