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C Fehér, E Múñez Rubio, P Merino Amador, A Delgado-Iribarren Garcia-Campero, M Salavert, E Merino, E Maseda Garrido, V Díaz-Brito, M J Álvarez, J Mensa
The objective of this study was to evaluate the efficacy and safety of fidaxomicin in the real-life clinical setting. This was a retrospective cohort of patients with Clostridium difficile infection (CDI) treated with fidaxomicin in 20 Spanish hospitals between July 2013 and July 2014. Clinical cure, 30-day recurrence, 30-day mortality, sustained cure, and factors associated with the failure to achieve sustained cure were analyzed. Of the 72 patients in the cohort 41 (56.9 %) had a fatal underlying disease...
October 8, 2016: European Journal of Clinical Microbiology & Infectious Diseases
Asser Mathiassen Oppfeldt, Jens F Dahlerup, Lisbet A Christensen, Christian L Hvas
Faecal microbiota transplantation (FMT) is increasingly being used to treat refractory and recurring Clostridium difficile infection (CDI). Although FMT appears to be safe and highly effective in patients with a preserved colon and immunocompetence, its use in patients with inflammatory bowel disease (IBD) who are on immunomodulating therapies is controversial. In particular, patients who have undergone colectomy may have different treatment responses to FMT. In this case report, we describe the successful use of FMT in a female patient aged 19 years with Crohn's disease who underwent ileorectal anastomosis following colectomy...
2016: BMJ Case Reports
Andrew I T Hebbard, Monica A Slavin, Caroline Reed, Benjamin W Teh, Karin A Thursky, Jason A Trubiano, Leon J Worth
Clostridium difficile infection (CDI) is a significant cause of healthcare-associated diarrhoea, and the emergence of endemic strains resulting in poorer outcomes is recognised worldwide. Patients with cancer are a specific high-risk group for development of infection. Areas covered: In this review, modifiable and non-modifiable risk factors for CDI in adult patients with haematological malignancy or solid tumours are evaluated. In particular, the contribution of antimicrobial exposure, hospitalisation and gastric acid suppression to risk of CDI are discussed...
November 2016: Expert Review of Anti-infective Therapy
María Jesús Vivancos-Gallego, M Ángeles Jiménez-López, Francesca Gioia, Dione Ibañez-Segura, José Romero-Vivas, Javier Cobo
Recurrences of Clostridium difficile infections lead to hospital readmissions and high costs, in addition to the suffering and frustration for the patients. Fidaxomicin has recently been introduced as a new antibiotic that has been shown to significantly reduce the recurrence of this infection. Despite this superiority, its high cost has led to very restrictive policies in its use, as such that many institutions only use it in patients with multiple recurrences. While waiting for new predictive clinical tools, we propose the development of scoring systems that allow the more high-risk patients to be treated earlier...
September 3, 2016: Enfermedades Infecciosas y Microbiología Clínica
Caroline H Chilton, Grace S Crowther, Helen Ashwin, Chris M Longshaw, Mark H Wilcox
BACKGROUND: We have previously shown that fidaxomicin instillation prevents spore recovery in an in-vitro gut model, whereas vancomycin does not. The reasons for this are unclear. Here, we have investigated persistence of fidaxomicin and vancomycin on C. difficile spores, and examined post-antibiotic exposure spore recovery, outgrowth and toxin production. METHODS: Prevalent UK C. difficile ribotypes (n = 10) were incubated with 200mg/L fidaxomicin, vancomycin or a non-antimicrobial containing control for 1 h in faecal filtrate or Phosphate Buffered Saline...
2016: PloS One
Dhara N Shah, Fay S Chan, Nandita Kachru, Krutina P Garcia, Holly E Balcer, April P Dyer, John E Emanuel, Michelle D Jordan, Katherine T Lusardi, Geri Naymick, Radhika S Polisetty, Lanny Sieman, Ashley M Tyler, Michael L Johnson, Kevin W Garey
PURPOSE: Fidaxomicin use in real-world clinical practice, especially for severe Clostridium difficile infection (CDI), is mainly based on single-center observational studies. The purpose of this pharmacoepidemiology study was to assess outcomes of patients given fidaxomicin based on episode number and use of concomitant antibiotics. METHODS: Fidaxomicin use over time across included hospitals in the United States was assessed using a large inpatient drug utilization database...
2016: SpringerPlus
Greg Hussack, Jamshid Tanha
Clostridium difficile continues to be one of the most prevalent hospital-acquired bacterial infections in the developed world, despite the recent introduction of a novel and effective antibiotic agent (fidaxomicin). Alternative approaches under investigation to combat the anaerobic Gram-positive bacteria include fecal transplantation therapy, vaccines, and antibody-based immunotherapies. In this review, we catalog the recent advances in antibody-based approaches under development and in the clinic for the treatment of C...
2016: Clinical and Experimental Gastroenterology
Fred Arthur Zar
No abstract text is available yet for this article.
July 19, 2016: Annals of Internal Medicine
Eric T Slayton, Abigail S Hay, Charles K Babcock, Timothy E Long
INTRODUCTION: There are limited number of approved therapies for C. difficile infections (CDIs) and new treatments are needed to decrease recurrence rates. Over the past 5 years, four novel antibiotics have been evaluated in clinical trials that offer distinct advantages over existing therapies for the treatment of CDI. AREAS COVERED: This article reviews the preclinical and clinical studies of cadazolid, LFF571, ridinilazole, and surotomycin. The advantages that these antibiotics may have in the treatment of CDI is compared with current therapies metronidazole, vancomycin, and fidaxomicin...
July 25, 2016: Expert Review of Anti-infective Therapy
Christine Lee, Thomas J Louie, Karl Weiss, Louis Valiquette, Marvin Gerson, Wendy Arnott, Sherwood L Gorbach
Background. This analysis examined the efficacy of fidaxomicin versus vancomycin in 406 Canadian patients with Clostridium difficile infection (CDI), based on data from 2 randomized, clinical trials. Methods. Patients received fidaxomicin or vancomycin 1. Patients were assessed for clinical response recurrence of infection and sustained clinical response for 28 days after treatment completion. Patients at increased risk of recurrence were subjected to subgroup analyses. Results. Clinical response rates for fidaxomicin (90...
2016: Canadian Journal of Infectious Diseases & Medical Microbiology
J Beneš, S Polívková
The advantages and disadvantages of various antibiotics used in the treatment of Clostridium difficile infection (CDI) are compared with respect to their pharmacokinetic and pharmacodynamic properties. Recommendations are made for their optimal use in clinical practice. Metronidazole is suitable for the treatment of mild forms of CDI which are essentially self-limiting. Vancomycin kills clostridia reliably but the treatment is encumbered with considerable risk of recurrence. This can be decreased by shortening the treatment to seven days and then switching to a (pulse, taper, chaser) regimen to prevent recurrence or by active restoration of the intestinal ecosystem (fecal transplant)...
2016: Epidemiologie, Mikrobiologie, Imunologie
Dalia Deak, Kevin Outterson, John H Powers, Aaron S Kesselheim
A weak antibiotic pipeline and the increase in drug-resistant pathogens have led to calls for more new antibiotics. Eight new antibiotics were approved by the U.S. Food and Drug Administration (FDA) between January 2010 and December 2015: ceftaroline, fidaxomicin, bedaquiline, dalbavancin, tedizolid, oritavancin, ceftolozane-tazobactam, and ceftazidime-avibactam. This study evaluates the development course and pivotal trials of these antibiotics for their innovativeness, development process, documented patient outcomes, and cost...
September 6, 2016: Annals of Internal Medicine
Daniel R Knight, Thomas V Riley
OBJECTIVES: Increasing reports of genetic overlap between animal and human sources of Clostridium difficile necessitate an understanding of antimicrobial susceptibility and resistance in these populations. In this study, we sought to investigate the in vitro activities of 13 antimicrobials against a unique collection of clade 5 C. difficile isolates of Australian animal and human origin. METHODS: The collection comprised 171 C. difficile strains of human (n = 91) and animal (n = 80) origin in Australia in the last decade...
August 2016: Journal of Antimicrobial Chemotherapy
Bradley T Endres, Eugénie Bassères, Ali Memariani, Long Chang, M Jahangir Alam, Richard J Vickers, Ioannis A Kakadiaris, Kevin W Garey
Clostridium difficile is a significant cause of nosocomial-acquired infection that results in severe diarrhea and can lead to mortality. Treatment options for C. difficile infection (CDI) are limited, however, new antibiotics are being developed. Current methods for determining efficacy of experimental antibiotics on C. difficile involve antibiotic killing rates and do not give insight into the drug's pharmacologic effects. Considering this, we hypothesized that by using scanning electron microscopy (SEM) in tandem to drug killing curves, we would be able to determine efficacy and visualize the phenotypic response to drug treatment...
August 2016: Anaerobe
Abhishek Deshpande, Kelly Hurless, Jennifer L Cadnum, Laurent Chesnel, Lihong Gao, Luisa Chan, Sirisha Kundrapu, Alexander Polinkovsky, Curtis J Donskey
The use of oral vancomycin or metronidazole for treatment of Clostridium difficile infection (CDI) may promote colonization by health care-associated pathogens due to disruption of the intestinal microbiota. Because the macrocyclic antibiotic fidaxomicin causes less alteration of the intestinal microbiota than vancomycin, we hypothesized that it would not lead to a loss of colonization resistance to vancomycin-resistant enterococci (VRE) and extended-spectrum-β-lactamase-producing Klebsiella pneumoniae (ESBL-Kp)...
July 2016: Antimicrobial Agents and Chemotherapy
Abrar K Thabit, M Jahangir Alam, Mohammed Khaleduzzaman, Kevin W Garey, David P Nicolau
BACKGROUND: To assess the effect of fidaxomicin and vancomycin on Clostridium difficile toxins and correlation with clinical and microbiologic outcomes. METHODS: Hospitalized patients with C. difficile infection were randomly assigned a 10-day course of fidaxomicin or vancomycin. Stool samples collected at baseline (day 0), mid-therapy (days 3-5), end of therapy (days 10-13) and follow-up (days 19-38) were assessed for quantity of toxins A and B as well as spore and vegetative cells counts...
2016: Annals of Clinical Microbiology and Antimicrobials
Andrew Ofosu
Clostridium difficile (C. difficile) infection (CDI) is the most common cause of -healthcare-associated infections in US hospitals. The epidemic strain NAP1/BI/ribotype 027 accounts for outbreaks worldwide, with increasing mortality and severity. CDI is acquired from an endogenous source or from spores in the environment, most easily acquired during the hospital stay. The use of antimicrobials disrupts the intestinal microflora enabling C. difficile to proliferate in the colon and produce toxins. Clinical diagnosis in symptomatic patients requires toxin detection from stool specimens and rarely in combination with stool culture to increase sensitivity...
April 2016: Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology
Maureen Watt, Charles McCrea, Sukhvinder Johal, John Posnett, Jameel Nazir
PURPOSE: Clostridium difficile infection (CDI) represents a significant economic healthcare burden, especially the cost of recurrent disease. Fidaxomicin produced significantly lower recurrence rates and higher sustained cure rates in clinical trials. We evaluated the cost-effectiveness and budget impact of fidaxomicin compared with vancomycin in Germany in the first-line treatment of patient subgroups with CDI at increased risk of recurrence. METHODS: A semi-Markov model was used to compare the cost-effectiveness and budget impact of fidaxomicin vs...
October 2016: Infection
Tian-tian Tian, Jian-hong Zhao, Jing Yang, Cui-xin Qiang, Zhi-rong Li, Jing Chen, Kai-yue Xu, Qing-qing Ciu, Ru-xin Li
Clostridium difficile is a spore-forming, gram-positive, anaerobic bacillus that can cause C. difficile infection (CDI). However, only a few studies on the prevalence and antibiotic resistance of C. difficile in healthy individuals in China have been reported. We employed a spore enrichment culture to screen for C. difficile in the stool samples of 3699 healthy Chinese individuals who were divided into 4 groups: infants younger than 2 years of age and living at home with their parents; children aged 1 to 8 years of age and attending three different kindergarten schools; community-dwelling healthy adult aged 23-60 years old; and healthcare workers aged 28-80 years old...
2016: PloS One
Lauren Lapointe-Shaw, Kim L Tran, Peter C Coyte, Rebecca L Hancock-Howard, Jeff Powis, Susan M Poutanen, Susy Hota
OBJECTIVE: To assess the cost-effectiveness of six treatment strategies for patients diagnosed with recurrent Clostridium difficile infection (CDI) in Canada: 1. oral metronidazole; 2. oral vancomycin; 3.oral fidaxomicin; 4. fecal transplantation by enema; 5. fecal transplantation by nasogastric tube; and 6. fecal transplantation by colonoscopy. PERSPECTIVE: Public insurer for all hospital and physician services. SETTING: Ontario, Canada. METHODS: A decision analytic model was used to model costs and lifetime health effects of each strategy for a typical patient experiencing up to three recurrences, over 18 weeks...
2016: PloS One
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