722 - Effectiveness of Fidaxomicin versus Oral Vancomycin in the Treatment of Recurrent Clostridioides difficile

Background: The 2017 IDSA/SHEA clinical practice guidelines for Clostridioides difficile infection (CDI) recommend treating recurrent episodes with fidaxomicin or oral vancomycin, but there is little evidence to support one strategy over another, particularly beyond the first recurrence. The aim of this study was to compare clinical outcomes in patients with recurrent CDI treated with vancomycin vs. fidaxomicin.

Methods: This was a retrospective study evaluating inpatients with recurrent CDI treated with vancomycin or fidaxomicin between January 1, 2013 and May 1, 2019. The primary outcome was CDI recurrence. Secondary outcomes included re-infection, treatment failure, infection-related length of stay (IRLOS), and in-hospital all-cause mortality (IHACM). Data collected included demographics; number of previous CDI episodes; CDI therapy; time to recurrence and re-infection; exposure to broad-spectrum antibiotics, proton pump inhibitors, and probiotics. Wilcoxon rank sum, Pearson chi-square, or Fisher’s exact tests were utilized, as appropriate. A multivariable logistic regression (MLR) model was used to estimate the adjusted odds ratio and 95% confidence interval assessing recurrence while adjusting for confounding variables. A survival analysis was also conducted.

Results: One hundred thirty-five patients met inclusion criteria (n = 35 fidaxomicin vs. n = 100 vancomycin). Of these, 42 (31%) had experienced at least 2 CDI episodes prior to their index recurrence. There was no difference in CDI recurrence [7 (20%) fidaxomicin vs. 11 (11%) vancomycin, p=0.18]; this persisted in the MLR model (OR 0.85 [95% CI 0.27-2.7]) and survival analysis (P = 0.1954). Additionally, there was no difference in re-infection rate (p=0.73), treatment failure (p=0.13), IRLOS (p=0.19), or IHACM (p=0.65).

Conclusion: Oral vancomycin and fidaxomicin are both suitable treatment options in the setting of recurrent CDI.