Background We aimed to describe the frequency of use and effectiveness of bezlotoxumab (BZX) and fecal microbiota transplantation (FMT) in patients with Clostridioides difficile infection (CDI) in real-world practice. Methods Retrospective study conducted in a university hospital in which adult patients treated with BZX or FMT from January-2018 to April-2021 were included. The primary objective was to evaluate the effectiveness of BZX and FMT in preventing early (within 8 weeks) and late (within one year) CDI recurrences (rCDI). A multivariate analysis of risk factors for early recurrence was performed. Results Of 1,377 consecutive CDI episodes, 117 (8.5%) received BZX or FMT, with full information available for 100 of the episodes: 51 received BZX and 49 received FMT. BZX was used mostly in immunosuppressed patients (66.7%) and in first episodes or first recurrences in 70.6% of the cases. FMT was prescribed only in CDI recurrences. Despite the different conditions of the patients, there were no significant differences between BZX and FMT in preventing early rCDI (19.6% vs. 24.5%, p = 0.55) or late rCDI (9.8% vs. 18.4%, p = 0.31). In the multivariate analysis, risk factors for recurrence were presence of ≥ 2 previous rCDI episodes (OR 2.90, 95%CI 1.03-8.63) and use of non-CDI antibiotics (OR 3.45, 95%CI 1.24-9.57). Conclusions BZX and FMT were infrequently used in a real-world practice. Both treatments had similar effectiveness in preventing CDI recurrence despite its application to different populations.
Patients' median age at NSCLC diagnosis was 62 (53-67) years; 73.3% (121/165) men; 69.09% (114/165) stage IIIB-V; 59.39% (98/165) adenocarcinoma; 58.18% (96/165) family history of cancer; 24.24% (40/165) previous lung disease; EGFR status: 10.91% (18/165) mutated. Chemotherapy agents: 18.29% (30/164) gemcitabine; 21.34% (35/164) paclitaxel; 24.39% (40/164); 35.98% (59/164). Nephrotoxicity: 17.58% (29/165).Patients carrying the CYP27B1-rs4646536 (p=0.0312; OR 0.32; CI 95% 0.10 to 0.84; AG vs AA); CYP27B1-rs3782130 (p=0.0247; OR 0.22; CI 95% 0.05 to 0.85; CC vs G); CYP27B1-rs703842 (p=0.0121; OR 0.15; CI 95% 0.03 to 0.67; CT vs CC) and CYP27B1-rs10877012 (p=0.0239; OR 4.50; CI 95% 1.17 to 17.2; TT vs G), were associated with nephrotoxicity. However, for CYP2R1-rs10741657 we did not find a statistically significant association. Conclusion and relevanceOur results suggest that rs4646536, rs3782130, rs703842 and rs10877012 influence nephrotoxicity in platinum-based chemotherapy. CYP27B1 is the only enzyme capable of activating vitamin D. Therefore, genetic study of these polymorphisms could be used as a toxicity prediction biomarker in NSCLC patients undergoing platinum-based chemotherapy.
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