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Fidaxomicin versus oral vancomycin for severe Clostridium difficile infection: a retrospective cohort study.
Clin Microbiol Infect. 2018 Dec 21;:
Authors: Gentry CA, Nguyen PK, Thind S, Kurdgelashvili G, Skrepnek GH, Williams RJ
Abstract
OBJECTIVES: This study was conducted to compare clinical outcomes of fidaxomicin versus oral vancomycin in the management of severe Clostridium difficile infection (CDI).
METHODS: The investigation was a retrospective, multicenter, propensity score-matched analysis using a national clinical administrative database. Veterans treated for severe CDI from any Veterans Affairs Medical Center between June 1, 2011 and June 30, 2017 were included if they received fidaxomicin or an oral vancomycin regimen for treatment. The two groups were matched by the nearest-neighbor method from a propensity score derived from independent variables associated with the selection of a fidaxomicin course.
RESULTS: Propensity score matching resulted in two well-matched cohorts consisting of 213 fidaxomicin and 639 oral vancomycin courses. No statistically-significant difference was found for the primary outcome of combined clinical failure or recurrence (68/213 {31.9%} vs. 163/639 {25.5%}, respectively, P = .071). Additionally, no statistically significant differences were found for the secondary outcomes of 30-day (23/213 {10.8%} vs 75/639 {11.7%}, respectively, P = .71), 90-day (48/213 {22.5%} vs 140/639 {21.9%}, respectively, P = .85), and 180-day mortality (62/213 {29.1%} vs 186/639 {29.1%}, respectively, P = 1.0) between the two treatment groups.
CONCLUSIONS: Courses of fidaxomicin or oral vancomycin for severe CDI resulted in similar treatment outcomes. Study findings are consistent with current treatment guideline recommendations for use of either agent in the management of severe CDI.
PMID: 30583055 [PubMed - as supplied by publisher]