Background: The use of fidaxomicin is recommended as first-line therapy for all patients with Clostridioides difficile infection (CDI). However, real-world studies have shown conflicting evidence of superiority.
Methods: We conducted a retrospective single-center study of patients diagnosed with CDI between 2011 and 2021. A primary composite outcome of clinical failure, 30-day relapse, or CDI-related death was used. A multivariable cause-specific Cox proportional hazards model was used to evaluate fidaxomicin compared to vancomycin in preventing the composite outcome. A separate model was fit on a subset of patients with C. difficile ribotypes adjusting for ribotype.
Results: There were 598 patients included, of whom 84 received fidaxomicin. The primary outcome occurred in 8 (9.5%) in the fidaxomicin group compared to 111 (21.6%) in the vancomycin group. The adjusted multivariable model showed fidaxomicin was associated with 63% reduction in the risk of the composite outcome compared to vancomycin (hazard ratio [HR] = 0.37; 95% confidence interval [CI], .17-.80). In the 337 patients with ribotype data after adjusting for ribotype 027, the results showing superiority of fidaxomicin were maintained (HR = 0.19; 95% CI, .05-.77).
Conclusions: In the treatment of CDI, we showed that real-world use of fidaxomicin is associated with lower risk of a composite end point of treatment failure.
Keywords: Clostridioides difficile; CDI; fidaxomicin; oral vancomycin; ribotype 027.
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