Characteristics and predictors of treatment failure with intravenous tigecycline monotherapy among adult patients with severe Clostridioides (Clostridium) difficile infection: a single-centre observational cohort study

Szabó, Bálint Gergely; Duma, Lilla; Lenart, Katalin Szidonia; Kiss, Rebeka; Vad, Eszter; Petrik, Borisz; Ostorházi, Eszter; Kádár, Béla

doi:10.1016/j.diagmicrobio.2020.115231

Cited by 3 publications

(4 citation statements)

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“…76 While there have been further observational cohort studies that have demonstrated efficacy of tigecycline as an adjunct therapy in severe or fulminant disease, several other studies found no benefit compared to standard of care antimicrobials with regard to cure or recurrence rates. [77][78][79][80] The ESCMID and ASID therefore recommend consideration of combination therapy with tigecycline for refractory fulminant disease, though its use is not recommended by United States societies.…”

Section: Hocquart Et Al Performed a French Retrospective Cohort Study...mentioning

confidence: 99%

“…One single center retrospective cohort study of patients with severe CDI compared treatment with intravenous tigecycline (loading dose of 100 mg followed by 50 mg twice daily) to oral vancomycin with intravenous metronidazole and found improved cure rates (76% compared to 53%, respectively) with reduced rates of CDI‐related complications and sepsis 76 . While there have been further observational cohort studies that have demonstrated efficacy of tigecycline as an adjunct therapy in severe or fulminant disease, several other studies found no benefit compared to standard of care antimicrobials with regard to cure or recurrence rates 77–80 . The ESCMID and ASID therefore recommend consideration of combination therapy with tigecycline for refractory fulminant disease, though its use is not recommended by United States societies.…”

Section: Severe and Fulminant Diseasementioning

confidence: 99%

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Review article: The epidemiology and management of Clostridioides difficile infection—A clinical update

Clarke,

Allegretti

2024

Aliment Pharmacol Ther

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SummaryBackgroundClostridioides difficile is the most common cause of healthcare‐associated infection, and severe cases can result in significant complications. While anti‐microbial therapy is central to infection management, adjunctive therapies may be utilised as preventative strategies.AimThis article aims to review updates in the epidemiology, diagnosis, and management, including treatment and prevention, of C. difficile infections.MethodsA narrative review was performed to evaluate the current literature between 1986 and 2023.ResultsThe incidence of C. difficile infection remains significantly high in both hospital and community settings, though with an overall decline in recent years and similar surveillance estimates globally. Vancomycin and fidaxomicin remain the first line antibiotics for treatment of non‐severe C. difficile infection, though due to lower recurrence rates, infectious disease society guidelines now favour use of fidaxomicin. Faecal microbiota transplantation should still be considered to prevent recurrent C. difficile infection. However, in the past year the field has had a significant advancement with the approval of the first two live biotherapeutic products—faecal microbiota spores‐live brpk, an oral capsule preparation, and faecal microbiota live‐jslm—both indicated for the prevention of recurrent C. difficile infection, with additional therapies on the horizon.ConclusionAlthough the prevalence of C. difficile infection remains high, there have been significant advances in the development of novel therapeutics and preventative measures following changes in recent practice guidelines, and will continue to evolve in the future.

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Section: Hocquart Et Al Performed a French Retrospective Cohort Study...mentioning

confidence: 99%

Section: Severe and Fulminant Diseasementioning

confidence: 99%

Review article: The epidemiology and management of Clostridioides difficile infection—A clinical update

Clarke,

Allegretti

2024

Aliment Pharmacol Ther

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“…81 82 83 84 85 86 87 However, tigecycline is the only tetracycline with clinical data supporting its use for FCDI. To date, four small case series, 88 89 90 91 two larger case series, 92 93 two unmatched cohort studies, 94 95 one propensity score–adjusted cohort study, 96 and one propensity score–matched cohort study 97 have been published. The dose of tigecycline used in these studies was universally 100 mg once, followed by 50 mg twice daily.…”

Section: Antibiotic Therapymentioning

confidence: 99%

“…Although many of the patients included in these observational studies received concomitant FDX, MTZ, and/or VAN with tigecycline, several studies describe success with tigecycline monotherapy. 88 93 95 In a propensity score–adjusted cohort study, investigators compared all-cause inpatient mortality in patients who received tigecycline plus VAN and MTZ versus those who received MTZ and/or VAN. 96 They concluded that after adjusting for propensity score, the odds of mortality were similar between groups (OR, 0.71; 95% CI, 0.16–3.24).…”

Section: Antibiotic Therapymentioning

confidence: 99%

Fulminant Clostridioides difficile Infection: A Review of Treatment Options for a Life-Threatening Infection

Carlson

Gonzales-Luna

Garey

2022

Semin Respir Crit Care Med

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Fulminant Clostridioides difficile infection (FCDI) encompasses 3 to 5% of all CDI cases with associated mortality rates between 30 and 40%. Major treatment modalities include surgery and medical management with antibiotic and nonantibiotic therapies. However, identification of patients with CDI that will progress to FCDI is difficult and makes it challenging to direct medical management and identify those who may benefit from surgery. Furthermore, since it is difficult to study such a critically ill population, data investigating treatment options are limited. Surgical management with diverting loop ileostomy (LI) instead of a total abdominal colectomy (TAC) with end ileostomy has several appealing advantages, and studies have not consistently demonstrated a clinical benefit with this less-invasive strategy, so both LI and TAC remain acceptable surgical options. Successful medical management of FCDI is complicated by pharmacokinetic changes that occur in critically ill patients, and there is an absence of high-quality studies that included patients with FCDI. Recommendations accordingly include a combination of antibiotics administered via multiple routes to ensure adequate drug concentrations in the colon: intravenous metronidazole, high-dose oral vancomycin, and rectal vancomycin. Although fidaxomicin is now recommended as first-line therapy for non-FCDI, there are limited clinical data to support its use in FCDI. Several nonantibiotic therapies, including fecal microbiota transplantation and intravenous immunoglobulin, have shown success as adjunctive therapies, but they are unlikely to be effective alone. In this review, we aim to summarize diagnosis and treatment options for FCDI.

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Management ofClostridioides difficileinfection in adults and challenges in clinical practice: review and comparison of current IDSA/SHEA, ESCMID and ASID guidelines

Bishop

Tiruvoipati

2022

Journal of Antimicrobial Chemotherapy

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Clostridioides difficile infection (CDI) remains a significant clinical challenge both in the management of severe and severe-complicated disease and the prevention of recurrence. Guidelines released by the Infectious Diseases Society of America and Society for Healthcare Epidemiology of America (IDSA/SHEA) and ESCMID had some consensus as well as some discrepancies in disease severity classification and treatment recommendations. We review and compare the key clinical strategies from updated IDSA/SHEA, ESCMID and current Australasian guidelines for CDI management in adults and discuss relevant issues for clinicians, particularly in the management of severe-complicated infection. Updated IDSA/SHEA and ESCMID guidelines now reflect the increased efficacy of fidaxomicin in preventing recurrence and have both promoted fidaxomicin to first-line therapy with an initial CDI episode in both non-severe and severe disease and endorsed the role of bezlotoxumab in the prevention of recurrent infection. Vancomycin remains acceptable therapy and metronidazole is not preferred. For severe-complicated infection the IDSA/SHEA recommends high-dose oral ± rectal vancomycin and IV metronidazole, whilst in an important development, ESCMID has endorsed fidaxomicin and tigecycline as part of combination anti-CDI therapy, for the first time. The role of faecal microbiota transplantation (FMT) in second CDI recurrence is now clearer, but timing and mode of FMT in severe-complicated refractory disease still requires further study.

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Characteristics and predictors of treatment failure with intravenous tigecycline monotherapy among adult patients with severe Clostridioides (Clostridium) difficile infection: a single-centre observational cohort study

Cited by 3 publications

References 24 publications

Review article: The epidemiology and management of Clostridioides difficile infection—A clinical update

Review article: The epidemiology and management of Clostridioides difficile infection—A clinical update

Fulminant Clostridioides difficile Infection: A Review of Treatment Options for a Life-Threatening Infection

Management ofClostridioides difficileinfection in adults and challenges in clinical practice: review and comparison of current IDSA/SHEA, ESCMID and ASID guidelines

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