TY - JOUR
T1 - Retrospective evaluation of fidaxomicin versus oral vancomycin for treatment of Clostridium difficile infections in allogeneic stem cell transplant
AU - Prohaska, Laura
AU - Mahmoudjafari, Zahra
AU - Shune, Leyla
AU - Singh, Anurag
AU - Lin, Tara
AU - Abhyankar, Sunil
AU - Ganguly, Siddhartha
AU - Grauer, Dennis
AU - McGuirk, Joseph
AU - Clough, Lisa
N1 - Publisher Copyright:
© 2018 King Faisal Specialist Hospital & Research Centre
PY - 2018/12
Y1 - 2018/12
N2 - Objective/background: Clostridium difficile infection (CDI) is a potential complication during hematopoietic stem cell transplantation (HSCT), and no specific recommendations exist regarding treatment of CDI in allogeneic SCT patients. Use of metronidazole and oral vancomycin has been associated with clinical failure. Fidaxomicin has previously been found noninferior to the use of oral vancomycin for the treatment of CDI, and no studies have compared the use of oral vancomycin with fidaxomicin for the treatment of CDI in allogeneic SCT. Methods: This retrospective chart review included 96 allogeneic SCT recipients who developed CDI within 100 days following transplantation. Participants were treated with oral vancomycin (n = 52) or fidaxomicin (n = 44). The primary outcome was clinical cure, defined as no need for further retreatment 2 days following completion of initial CDI treatment. Secondary outcomes were global cure, treatment failure, and recurrent disease. Results: No differences in clinical cure were observed between patients receiving oral vancomycin or fidaxomicin (75% vs. 75%, p = 1.00). Secondary outcomes were similar between oral vancomycin and fidaxomicin in regards to global cure (66% vs. 67%, p =.508), treatment failure (28% vs. 27%, p =.571), and recurrent disease (7% vs. 5%, p =.747). In a subanalysis of individuals that developed acute graft-versus-host disease following CDI, the difference in mean onset of acute graft-versus-host disease was 21.03 days in the oral vancomycin group versus 32.88 days in the fidaxomicin group (p =.0031). Conclusion: The findings of this study suggest that oral vancomycin and fidaxomicin are comparable options for CDI treatment in allogeneic SCT patients within 100 days following transplant.
AB - Objective/background: Clostridium difficile infection (CDI) is a potential complication during hematopoietic stem cell transplantation (HSCT), and no specific recommendations exist regarding treatment of CDI in allogeneic SCT patients. Use of metronidazole and oral vancomycin has been associated with clinical failure. Fidaxomicin has previously been found noninferior to the use of oral vancomycin for the treatment of CDI, and no studies have compared the use of oral vancomycin with fidaxomicin for the treatment of CDI in allogeneic SCT. Methods: This retrospective chart review included 96 allogeneic SCT recipients who developed CDI within 100 days following transplantation. Participants were treated with oral vancomycin (n = 52) or fidaxomicin (n = 44). The primary outcome was clinical cure, defined as no need for further retreatment 2 days following completion of initial CDI treatment. Secondary outcomes were global cure, treatment failure, and recurrent disease. Results: No differences in clinical cure were observed between patients receiving oral vancomycin or fidaxomicin (75% vs. 75%, p = 1.00). Secondary outcomes were similar between oral vancomycin and fidaxomicin in regards to global cure (66% vs. 67%, p =.508), treatment failure (28% vs. 27%, p =.571), and recurrent disease (7% vs. 5%, p =.747). In a subanalysis of individuals that developed acute graft-versus-host disease following CDI, the difference in mean onset of acute graft-versus-host disease was 21.03 days in the oral vancomycin group versus 32.88 days in the fidaxomicin group (p =.0031). Conclusion: The findings of this study suggest that oral vancomycin and fidaxomicin are comparable options for CDI treatment in allogeneic SCT patients within 100 days following transplant.
KW - Allogeneic stem cell transplantation
KW - Clostridium difficile
KW - Fidaxomicin
KW - Vancomycin
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U2 - 10.1016/j.hemonc.2018.05.001
DO - 10.1016/j.hemonc.2018.05.001
M3 - Article
C2 - 29928848
AN - SCOPUS:85049567432
VL - 11
SP - 233
EP - 240
JO - Hematology/ Oncology and Stem Cell Therapy
JF - Hematology/ Oncology and Stem Cell Therapy
SN - 1658-3876
IS - 4
ER -