Clinical outcomes of fidaxomicin vs oral vancomycin in recurrent Clostridium difficile infection

WHAT IS KNOWN AND OBJECTIVE: Recurrent Clostridium difficile infection (CDI) occurs after initial treatment in approximately 20%-30% of patients, regardless of therapy chosen. The objective of this study was to assess clinical outcomes of recurrent CDI treated with fidaxomicin or oral vancomycin. METHODS: This study was a retrospective, propensity score-matched nationwide analysis of adult patients with first or second CDI recurrence prescribed fidaxomicin or oral vancomycin from any Veterans Affairs Medical Center between June 2011 and December 2015. The primary outcome was evidence of clinical failure or 90-day recurrence. RESULTS AND DISCUSSION: Univariate variables associated with failure or recurrence were identified among 65 fidaxomicin-treated episodes and 1065 vancomycin-treated episodes and placed into a multivariable logistic regression model. Propensity scores were calculated from this model; 195 vancomycin-treated episodes were matched by the next-nearest propensity score to 65 fidaxomicin-treated episodes. CDI failure or recurrence was similar between the two groups (18 of 65 [27.7%] fidaxomicin-treated episodes vs 42 of 195 [21.5%] vancomycin-treated episodes [P = 0.31]). Multivariate analysis demonstrated only baseline second recurrence episode, not choice of drug, as independently associated with failure or recurrence. WHAT IS NEW AND CONCLUSION: There was no difference in the combined outcome of clinical failure or 90-day recurrence between fidaxomicin and oral vancomycin in the treatment of first or second recurrent CDI.