Wilcox, Mark H., Cornely, Oliver A., Guery, Benoit, Longshaw, Chris, Georgopali, Areti, Karas, Andreas, Kazeem, Gbenga, Palacios-Fabrega, Jose Alejandro and Vehreschild, Maria J. G. T. (2019). Microbiological Characterization and Clinical Outcomes After Extended-Pulsed Fidaxomicin Treatment for Clostridioides difficile Infection in the EXTEND Study. Open Forum Infect. Dis., 6 (11). CARY: OXFORD UNIV PRESS INC. ISSN 2328-8957

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Abstract

Background. Clostridioides (Clostridium) difficile infection (CDI) is diagnosed using clinical signs and symptoms plus positive laboratory tests. Recurrence of CDI after treatment is common, and coinfection with other enteric pathogens may influence clinical outcomes. Methods. We aimed to assess rates of C difficile positivity, by enzyme-linked immunosorbent assay (ELISA) toxin A/B and BioFire FilmArray, and the effect of enteric coinfection on clinical outcomes, using samples from the EXTEND study of extendedpulsed fidaxomicin (EPFX) versus standard vancomycin. Results. All 356 randomized and treated patients tested positive for C difficile toxin A/B by local tests; a majority (225 of 356, 63.2%) also tested positive by both ELISA and BioFire. Most stool samples taken at screening tested positive for C difficile only using BioFire (EPFX: 112 of 165, 69.7%; vancomycin: 118 of 162, 72.8%). Of the 5 patients who failed treatment and had stool samples available, all (1) had tested negative for C difficile by BioFire at screening and (2) were negative by ELISA at time of treatment failure. When analyzed by BioFire results at screening, rates of sustained clinical cure at 30 days after end of treatment were numerically higher with EPFX than with vancomycin for almost all patients, except for those who tested negative for C difficile but positive for another pathogen. However, these outcome differences by presence of coinfection did not reach statistical significance. Wholegenome sequencing analysis determined that 20 of 26 paired samples from patients with recurrence were reinfections with the same C difficile strain. Conclusions. Testing for presence of copathogens in clinical trials of antibiotics could help to explain clinical failures.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Wilcox, Mark H.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Cornely, Oliver A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Guery, BenoitUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Longshaw, ChrisUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Georgopali, AretiUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Karas, AndreasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kazeem, GbengaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Palacios-Fabrega, Jose AlejandroUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Vehreschild, Maria J. G. T.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-128457
DOI: 10.1093/ofid/ofz436
Journal or Publication Title: Open Forum Infect. Dis.
Volume: 6
Number: 11
Date: 2019
Publisher: OXFORD UNIV PRESS INC
Place of Publication: CARY
ISSN: 2328-8957
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
VANCOMYCIN; MICROBIOME; RECURRENCE; SOCIETY; UPDATEMultiple languages
Immunology; Infectious Diseases; MicrobiologyMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/12845

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