Fidaxomicin in the treatment of colitis due to Clostridium difficile: preliminary results

Francesco Cortese, Marcello Meledandri, Milva Ballardini, Anna Ferrari

DOI: https://doi.org/10.7175/cmi.v8i1S.956

Abstract

The incidence of Clostridium difficile infections (CDI) and Clostridium difficile-Associated Diarrhea (CDAD) is increasing in Canada, USA, and Europe and represents a considerable clinical problem. Both naïve and hypervirulent strains can be considered as opportunistic bacteria affecting immunocompromised, antibiotic-treated, critical, or subcritical patients with a microbiota disruption. CDI arising is strictly related to antibiotic, single or combined, and/or proton pump inhibitor treatment. CDI can cause a syndrome with systemic involvement and complex treatment, sometimes requiring surgical interventions (e.g. colectomy in fulminant colitis). Antibiotic treatment with metronidazole by mouth is the first choice and generally vancomycin is administered in case of lack of effectiveness. Fidaxomicin is a new macrocyclic antibiotic for C. difficile with microflora-sparing properties. This paper reports our initial experience in 11 patients with non-responder or relapsing CDIs. Fidaxomicin was effective in 10 cases (91%). Only one patient with an active ulcerative colitis did not respond and was treated with fecal-microbiota transplantation. In two patients diarrhea persisted, but just the ulcerative colitis one was C. difficile-related. No adverse events were experienced.

Keywords

Clostridium difficile; Fidaxomicin; Microbiota; Diarrhea; Nosocomial infections

Full Text:

HTML PDF

References

  • Mattila E, Akkila P, Mattila PS, et al. Extraintestinal Clostridium difficile Infections. Clin Infect Dis 2013; 57: e148-e153
  • Johnson S. Recurrent Clostridium difficile infection: A review of risk factors, treatments, and outcomes. J Infect 2009; 58: 403-10; http://dx.doi.org/10.1016/j.jinf.2009.03.010
  • Freeman J, Bauer MP, Baines SD, et al. The changing epidemiology of Clostridium difficile infections. Clin Microb Rev 2010; 23: 529-49; http://dx.doi.org/10.1128/CMR.00082-09
  • Rupnik M, Wilcox MH, Gerding DN. Clostridium difficile infection: new developments in epidemiology and pathogenesis. Nat Rev Microbiol 2009; 7: 529-34; http://dx.doi.org/10.1038/nrmicro2164
  • Zilberberg MD, Shorr AF. Preventing Clostridium difficile infection in the Intensive Care Unit. Crit Care Clin 2013; 29: 11-8; http://dx.doi.org/10.1016/j.ccc.2012.10.006
  • Morris AM, Jobe BA, Stoney M et al. Clostridium difficile colitis. Arch Surg 2002; 137: 1096-100; http://dx.doi.org/10.1001/archsurg.137.10.1096
  • Kelly CP, LaMont T. Clostridium difficile – more difficult than ever. N Engl J Med 2008; 359: 1932-40; http://dx.doi.org/10.1056/NEJMra0707500
  • Pépin J, Alary M-E, Valiquette L, et al. Increasing risk of relapse after treatment of Clostridium difficile colitis in Quebec, Canada. Clin Infect Dis 2005; 40: 1591-7; http://dx.doi.org/10.1086/430315
  • Di Bella S, Musso M, Cataldo MA, et al. Clostridium difficile infection in Italian urban hospitals: data from 2006 through 2011. BMC Infect Dis 2013; 13: 146-52; http://dx.doi.org/10.1186/1471-2334-13-146
  • Foulke GE, Silva J. Clostridium difficile in the intensive care unit: Management problems and prevention issues. Crit Care Med 1989: 17: 822-6; http://dx.doi.org/10.1097/00003246-198908000-00020
  • Jones AM, Kuijper EJ, Wilcox MH. Clostridium difficile: A European perspective. J Infect 2013; 66: 115-28; http://dx.doi.org/10.1016/j.jinf.2012.10.019
  • Owens RC Jr, Donskey CJ, Gaynes RP, et al. Antimicrobial-associated risk factors for Clostridium difficile. Clin Infect Dis 2008; 46: S19-S31; http://dx.doi.org/10.1086/521859
  • Ricciardi R, Rothenberger DA, Madoff RD, et al. Increasing prevalence and severity of Clostridium difficile colitis in hospitalized patients in the United States. Arch Surg 2007; 142: 624-31; http://dx.doi.org/10.1001/archsurg.142.7.624
  • Kachrimanidou M, Malisiovas N. Clostridium difficile infection: a comprehnsive review. Clin Rev Microbiol 2011; 37: 178-87
  • Leekha S, Aronhalt KC, Sloan LM, et al. Asymptomatic Clostridium difficile colonization in a tertiary care hospital: Admission prevalence and risk factors. Am J Infect Control 2013; 41: 390-3; http://dx.doi.org/10.1016/j.ajic.2012.09.023
  • Lungulescu OA, Cao W, Gatskevich E, et al. CSI: a severity index for Clostridium difficile infection at the time of admission. J Hosp Infect 2011; 79: 151-4; http://dx.doi.org/10.1016/j.jhin.2011.04.017
  • Belmares J, Gerding DN, Parada JP, et al. Outcome of metronidazole therapy for Clostridium difficile disease and correlation with a scoring system. J Infect 2007; 55: 495-501; http://dx.doi.org/10.1016/j.jinf.2007.09.015
  • Hu MY, Katchar K, Kyne L, et al. Prospective derivation and validation of a clinical prediction rule for recurrent Clostridium difficile infection. Gastroenterology 2009; 136: 1206-14; http://dx.doi.org/10.1053/j.gastro.2008.12.038
  • Dudukgian H, Sie E, Gonzalez-Riuz C, et al. C. difficile colitis-predictors of fatal outcome. J Gastrointest Surg 2010; 14: 315-22; http://dx.doi.org/10.1007/s11605-009-1093-2
  • Chakra CNA, Pepin J, Valiquette L. Prediction tools for unfavourable outcomes in Clostridium difficile infection: A systematic review. PlosOne 2012; 7: 1-8
  • Efron PA, Lottenberg L, Cuenca AG, et al. A genomic analysis of Clostridium difficile infections in blunt trauma patients. J Trauma Acute Care Surg 2013; 74: 334-8; http://dx.doi.org/10.1097/TA.0b013e3182789426
  • Lim SK, Stuart RL, Mackin KE, et al. Emergence of a ribotype 244 strain of Clostridium difficile associated with severe disease and related to the epidemic ribotype 027 strain. Clin Infect Dis 2014; 58: 1723-30; http://dx.doi.org/10.1093/cid/ciu203
  • McDonald LC, Killgore GE, Thompson A, et al. An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med 2005; 353: 2433-41; http://dx.doi.org/10.1056/NEJMoa051590
  • Loo VG, Poirier L, Miller MA, et al. A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med 2005; 353: 2442-9; http://dx.doi.org/10.1056/NEJMoa051639
  • Corbellini S, Piccinelli G, De Francesco MA, et al. Molecular epidemiology of Clostridium difficile strains from nosocomial-acquired infections. Folia Microbiol 2013: 59: 173-9; http://dx.doi.org/10.1007/s12223-013-0281-3
  • Garey KW, Sehti S, Yadav Y, et al. Meta-analysis to assess risk factors for recurrent Clostridium difficile infection. J Hosp Infect 2008; 70: 298-304; http://dx.doi.org/10.1016/j.jhin.2008.08.012
  • Byrn JC, Maun DC, Gingold DS, et al. Predictors of mortality after colectomy for fulminant Clostridium difficile colitis. Arch Surg 2008; 143: 150-4; http://dx.doi.org/10.1001/archsurg.2007.46
  • Sailhamer EA, Carson K, Chang Y, et al. Fulminant Clostridium difficile colitis. Arch Surg 2009; 144: 433-9; http://dx.doi.org/10.1001/archsurg.2009.51
  • Miller MA. Clinical management of Clostridium difficile-associated disease. Clin Infect Dis 2007; 45: S122-S128; http://dx.doi.org/10.1086/519257
  • Eaton SR, Mazuski JE. Overview of severe Clostridium difficile infection. Crit Care Clin 2013; 29: 827-39; http://dx.doi.org/10.1016/j.ccc.2013.06.004
  • Ananthakrishnan AN. Clostridium difficile infection: epidemiology, risk factors and management. Nat Rev Gastroenterol Hepatol 2011; 8:17-26; http://dx.doi.org/10.1038/nrgastro.2010.190
  • Poutanen SM, Simor AE. Clostridium difficile-associated diarrhea in adults. CMAJ 2004; 171: 51-8; http://dx.doi.org/10.1503/cmaj.1031189
  • Dubberke ER, Carling P, Carrico R, et al. Strategies to prevent Clostridium difficile infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014; 35: 628-45; http://dx.doi.org/10.1086/676023
  • Vonberg RP, Kuijper EJ, Wilcox MH, et al. Infection control measures to limit the spread of Clostridium difficile. Clin Microbiol Infect 2008; 14: S2-S20; http://dx.doi.org/10.1111/j.1469-0691.2008.01992.x
  • Konijeti GG, Sauk J, Shrime MG, et al. Cost-effectiveness of competing strategies for management of recurrent Clostridium difficile infection: A decision analysis. Clin Infect Dis 2014; 58: 1507-14; http://dx.doi.org/10.1093/cid/ciu128
  • Ghantoji SS, Sail K, Lairson DR, et al. Economic healthcare costs of Clostridium difficile infection: a systematic review. J Hosp Infect 2010; 74: 309-18; http://dx.doi.org/10.1016/j.jhin.2009.10.016
  • Sunenshine RH, McDonald LC. Clostridium difficile-associated disease: New challenges from an established pathogen. Clev Clin J Med 2006; 73: 187-97; http://dx.doi.org/10.3949/ccjm.73.2.187
  • Loo VG, Bourgault AM, Poirier L, et al. Host and pathogen factors for Clostridium difficile infection and colonization. N Engl J Med 2011; 365: 1693-703; http://dx.doi.org/10.1056/NEJMoa1012413
  • Alasmari F, Seiler SM, Hink T, et al. Prevalence and risk factors for asymptomatic Clostridium difficile carriage. Clin Infect Dis 2014; 59: 216-22; http://dx.doi.org/10.1093/cid/ciu258
  • Bignardi GE. Risk factors for Clostridium difficile infection. J Hospital Infect 1998; 40: 1-15; http://dx.doi.org/10.1016/S0195-6701(98)90019-6
  • Kelly CP. Can we identify patients at high risk of recurrent Clostridium difficile infection? Clin Microbiol Infect 2012: 18: S21-S27; http://dx.doi.org/10.1111/1469-0691.12046
  • Brown KA, Fisman DN, Moineddin R, et al. The magnitude and duration of Clostridium difficile infection risk associated with antibiotic therapy: A hospital cohort study. PlosOne 2014; 9: 1-9
  • Stevens V, Dumyati G, Fine LS, et al. Cumulative antibiotic exposures over time and the risk of Clostridium difficile infection. Clin Infect Dis 2011; 53: 42-8; http://dx.doi.org/10.1093/cid/cir301
  • Borgmann S, Jakobiak T, Gruber H, et al. Association of ciprofloxacin prescriptions to outpatients to Clostridium difficile infections. Euro Surveill 2010; 15: pii 19479
  • Wren SM, Ahmed N, Jamal A, et al. Preoperative oral antibiotics in colorectal surgery increase the rate of Clostridium difficile colitis. Arch Surg 2005; 140: 752-6; http://dx.doi.org/10.1001/archsurg.140.8.752
  • Shah K, Pass LA, Cox M, et al. Evaluating contemporary antibiotics as a risk factor for Clostridium difficile infection in surgical trauma patients. J Trauma Acute Care Surg 2012; 72: 691-5; http://dx.doi.org/10.1097/TA.0b013e31823c5637
  • Kwok CS, Arthur AK, Anibueze CI, et al. Risk of Clostridium difficile infection with acid suppressing drugs and antibiotics: meta-analysis. Am J Gastroenterol 2012: 107: 1011-9; http://dx.doi.org/10.1038/ajg.2012.108
  • Linsky A, Gupta K, Lawler EV, et al. Proton Pump Inhibitors and risk for recurrent Clostridium difficile infection. Arch Int Med 2010; 170: 772-8; http://dx.doi.org/10.1001/archinternmed.2010.73
  • Rashid S, Rajan D, Iqbal J, et al. Inappropriate use of gastric acid suppression therapy in hospitalized patients with Clostridium difficile-Associated Diarrhea: A ten-year retrospective analysis. ISRN Gastroenterology 2012; 2012: 902320; http://dx.doi.org/10.5402/2012/902320
  • Janarthanan S, Ditah I, Adler DG, et al. Clostridium difficile-Associated Diarrhea and Proton Pump Inhibitor therapy: A meta-analysis. Am J Gastroenterol 2012; 107: 1001-10; http://dx.doi.org/10.1038/ajg.2012.179
  • Simor AE, Bradley SF, Strausbaugh LJ, et al. Clostridium difficile in long-term-care facilities for the elderly. Infect Control Hosp Epidemiol 2002; 23: 696-703; http://dx.doi.org/10.1086/501997
  • Hensgens MPM, Keessen EC, Squire MM, et al. Clostridium difficile infection in the community: a zoonotic disease? Clin Microbiol Dis 2012; 18: 635-45; http://dx.doi.org/10.1111/j.1469-0691.2012.03853.x
  • Vendatam G, Clark A, Chu M, et al. Clostridium difficile infection. Gut Microbes 2012; 3: 121-34; http://dx.doi.org/10.4161/gmic.19399
  • Karas JA, Enoch DA, Aliyu SH. A review of mortality due to Clostridium difficile infection. J Infect 2010; 61: 1-8; http://dx.doi.org/10.1016/j.jinf.2010.03.025
  • Olson A, Diebel LN, Liberati DM. Effect on host defenses on Clostridium difficile toxin-induced intestinal barrier injury. J Trauma Acute Care Surg 2013; 74: 983-90; http://dx.doi.org/10.1097/TA.0b013e3182858477
  • Kelly CP, Lyne L. The host immune response to Clostridium difficile. J Med Microbiol 2011; 60: 1070-9; http://dx.doi.org/10.1099/jmm.0.030015-0
  • De La Cochetière MF, Durand T, Lalande V, et al. Effect of antibiotic therapy on human fecal microbiota and the relation to the development of Clostridium difficile. Microbiol Ecol 2008; 56: 395-402; http://dx.doi.org/10.1007/s00248-007-9356-5
  • Peterson LR. Bad bugs, no drugs: No ESCAPE revisited. Clin Infect Dis 2009; 49; 902
  • Boucher HW, Talbot GH, Bradley JS, et al. Bad bugs, no drugs: No ESKAPE! An update from the Infectious Diseases Society of America. Clin Infect Dis 2009; 48: 1-12; http://dx.doi.org/10.1086/595011
  • Valiquette L, Pépin J, Do XV, et al. Prediction of complicated Clostridium difficile infection by pleural effusion and increased wall thickness on Computed Tomography. Clin Infect Dis 2009; 49: 554-60; http://dx.doi.org/10.1086/600879
  • Cornely OA, Miller MA, Fantin B, et al. Resolution of Clostridium difficile–Associated Diarrhea in patients with cancer treated with fidaxomicin or vancomycin. Clin Oncol 2013; 31: 2493-9; http://dx.doi.org/10.1200/JCO.2012.45.5899
  • El Feghaly RE, Stauber JL, Deych E, et al. Markers of intestinal inflammation, not bacterial burden, correlate with clinical outcomes in Clostridium difficile infection. Clin Infect Dis 2013; 56: 1713-21; http://dx.doi.org/10.1093/cid/cit147
  • Apisarnthanarak A, Razavi B, Mundy LM. Adjunctive intracolonic vancomycin for severe Clostridium difficile colitis: case series and review of the literature. Clin Infect Dis 2002; 35: 690-6; http://dx.doi.org/10.1086/342334

Refbacks

  • There are currently no refbacks.




© SEEd srl