Update on Treatment of Clostridioides difficile Infection

Cho, Janice M.; Pardi, Darrell S.; Khanna, Sahil

doi:10.1016/j.mayocp.2019.08.006

Cited by 34 publications

(66 citation statements)

References 73 publications

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“…Clostridioides difficile is responsible for the majority of health-care related infections and antibiotic-associated diarrhea, with an increasing morbidity and mortality globally in the last few years (Banawas, 2018;Cho et. al.…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of fecal microbiota transplant for the treatment of Clostridioides difficile diarrhea: a systematic review and meta‐analysis

Bascuñana

Veses

Sheth

2021

Lett Appl Microbiol

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In the era of antimicrobial resistance, infections due to Clostridioides difficile are on the rise. In this review we examine the use of FMT as a possible avenue to fight gastrointestinal infections produced by C. difficile. Published studies in this field vary greatly in design and outcome variables, leading to ambiguity when considering their clinical application. We believe that there is a significant lack of objective systematic reviews to inform clinical decision-making. Our objective is to evaluate the overall effectiveness and safety of FMT, as well as possible differences in effectiveness on the bases of the administration route employed.

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Section: Introductionmentioning

confidence: 99%

“…2018). Current treatment options for CDI include administration of vancomycin, fidaxomicin or metronizadol (Cho et. al.…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of fecal microbiota transplant for the treatment of Clostridioides difficile diarrhea: a systematic review and meta‐analysis

Bascuñana

Veses

Sheth

2021

Lett Appl Microbiol

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“…Printed with permission from Cho et al 11 Mayo Clin Proc 2020; 95: 758-769. bid, twice a day; FMT, fecal microbiota transplantation; IV, intravenously; po, orally; qid, four times a day; tid, three times a day. of 7 randomized control trials and 30 case series showed resolution of symptoms in 92% of the patients who underwent FMT.…”

Section: Introductionmentioning

confidence: 99%

“…45 In addition, standardized therapies which are enema-based (RBX2660) or capsule-based therapies (SER-109, CP101, RBX7455, VE303) are being developed. 11,14,33,[46][47][48][49][50][51][52][53] Details on these novel microbiome-based therapies are outlined in Table 3.…”

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confidence: 99%

Safety of fecal microbiota transplantation for Clostridioides difficile infection focusing on pathobionts and SARS-CoV-2

Yadav

Khanna

2021

Therap Adv Gastroenterol

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Clostridioides difficile infection (CDI) is a consequence of flagrant use of antibiotics, an aging population with increasing comorbidities, and increased hospitalizations. The treatment of choice for CDI is antibiotics (vancomycin or fidaxomicin), with a possibility of recurrent CDI despite lack of additional risk factors for CDI. For the last 10 years, fecal microbiota transplantation (FMT) has emerged as a promising therapy for recurrent CDI, with success rates of over 85% compared with less than 50% with antibiotics for multiple recurrent CDI. Along with the success of FMT, several adverse and serious adverse events with FMT have been reported. These range from self-limiting abdominal pain to death due to severe sepsis. This review focuses on the safety of FMT, emphasizing the reports of transmission of pathobionts like extended-spectrum beta lactamase Escherichia coli and Shiga toxin-producing E. coli. The severe acute respiratory syndrome coronavirus-2 is a potential pathogen that could be transmitted via FMT during the COVID-19 pandemic. The challenges faced by clinicians for donor screening, clinical trials, and other aspects of FMT during the pandemic are discussed.

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Efficacy and Health-Related Quality of Life Impact of Fecal Microbiota, Live-jslm: A Post Hoc Analysis of PUNCH CD3 Patients at First Recurrence of Clostridioides difficile Infection

Feuerstadt,

Allegretti,

Dubberke

et al. 2024

Infect Dis Ther

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Introduction Clostridioides difficile infection (CDI) causes symptoms of varying severity and negatively impacts patients’ health-related quality of life (HRQL). Despite antibiotic treatment, recurrence of CDI (rCDI) is common and imposes clinical and economic burdens on patients. Fecal microbiota, live-jslm (REBYOTA [RBL]) is newly approved in the USA for prevention of rCDI following antibiotic treatments. We analyzed efficacy and HRQL impact of RBL vs. placebo in patients at first rCDI using data from the phase 3 randomized, double-blind placebo-controlled clinical trial, PUNCH CD3. Methods This post hoc analysis included patients at first rCDI fromPUNCH CD3. Treatment success (i.e., absence of diarrhea within 8 weeks post-treatment) was analyzed adjusting for baseline patient characteristics. HRQL was measured using the Clostridioides difficile Quality of Life Survey (Cdiff32); absolute scores and change from baseline in total and domain (physical, mental, and social) scores were summarized and compared between arms. Analyses were conducted for the trial’s blinded phase only. Results Among 86 eligible patients (32.8% of the overall trial population, RBL 53 [61.6%], placebo 33 [38.4%]), RBL-treated patients had significantly lower odds of recurrence (i.e., greater probability of treatment success) at week 8 vs. placebo (odds ratio 0.35 [95% confidence interval 0.13, 0.98]). Probability of treatment success at week 8 was 81% for RBL and 60% for placebo, representing 21% absolute and 35% relative increases for RBL (crude proportions 79.2% vs. 60.6%; relative risk 0.53, p = 0.06). Additionally, RBL was associated with significantly higher Cdiff32 total (change score difference 13.5 [standard deviation 5.7], p < 0.05) and mental domain (16.2 [6.0], p < 0.01) scores vs. placebo from baseline to week 8. Conclusion Compared to placebo, RBL demonstrated a significantly higher treatment success in preventing further rCDI and enhanced HRQL among patients at first recurrence, establishing RBL as an effective treatment to prevent further recurrences in these patients. Trial Registration ClinicalTrials.gov Identifier NCT03244644. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-023-00907-w.

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Update on Treatment of Clostridioides difficile Infection

Cited by 34 publications

References 73 publications

Effectiveness of fecal microbiota transplant for the treatment of Clostridioides difficile diarrhea: a systematic review and meta‐analysis

Effectiveness of fecal microbiota transplant for the treatment of Clostridioides difficile diarrhea: a systematic review and meta‐analysis

Safety of fecal microbiota transplantation for Clostridioides difficile infection focusing on pathobionts and SARS-CoV-2

Efficacy and Health-Related Quality of Life Impact of Fecal Microbiota, Live-jslm: A Post Hoc Analysis of PUNCH CD3 Patients at First Recurrence of Clostridioides difficile Infection

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