2002. Clostridioides difficile Infection Recurrence Trends and Characteristics at a Community Medical Center


 
 
 Updated IDSA C. difficile Infection (CDI) guidelines recommend fidaxomicin as preferred therapy for initial infection as studies demonstrate increased sustained response 4 weeks after the end of therapy compared with vancomycin. Implementation of this is dependent upon available resources and vancomycin is recommended as an acceptable alternative. A course of fidaxomicin costs 30-50 times more than oral vancomycin and presents a pharmacoeconomic challenge. This study evaluated the incidence and characteristics of CDI recurrence in a community medical center to assess feasibility of implementing new CDI treatment recommendations.
 
 
 
 This multicenter, retrospective study was conducted at Scripps Health from 1/1/2019 - 12/31/2019. Adult patients with an initial CDI diagnosis (EIA antigen/toxin positive) were included. The primary endpoint was clinical cure, defined as no recurrent episodes of CDI one year after treatment. Secondary endpoints evaluated baseline characteristics and treatment between patients experiencing recurrence or no recurrence. Outcomes were assessed using count and proportion for descriptive data and Chi-Square, Fisher’s Exact and Logistic Regression for categorical data.
 
 
 
 A total of 223 patients were included, of which 18.4% (41/223) had recurrence. There was no difference in recurrence based on age > 65, sex, ethnicity, severity, and inpatient status (p > 0.05). There were no differences in comorbidities (kidney disease, cardiovascular disease, diabetes, malignancy, or pulmonary disease, p > 0.05) with the exception of cerebrovascular disease which was significantly higher in patients with recurrence (34.2% vs 13.2%, P = 0.001). Recurrence rates were similar between treatment groups (p = 0.383) which included vancomycin (n = 193, 20%), fidaxomicin (n = 4, 25%), metronidazole (n = 9, 0%), and vancomycin + metronidazole (n = 17, 12%).
 
 
 
 Presence of cerebrovascular disease was the only characteristic associated with a higher incidence of CDI recurrence. The majority of patients were treated with oral vancomycin, and there was no difference in recurrence based on treatment although there were low numbers in non-vancomycin cohorts. Vancomycin is an acceptable alternative for the management of CDI in our population.
 
 
 
 All Authors: No reported disclosures.
