Fidaxomicin Use and Clinical Outcomes for Clostridium difficile-Associated Diarrhea.

BACKGROUND: Fidaxomicin has been scrutinized because of its high acquisition cost. Real-world experience is needed to determine whether fidaxomicin has value in patients with Clostridium difficile-associated diarrhea (CDAD) and certain risk factors. METHODS: In this single-center, retrospective cohort study, patients 18 years or older with diarrheal symptoms and positive polymerase chain reaction assay for C. difficile toxin B gene or pseudomembranes were administered fidaxomicin between August 2011 and March 2013. Clinical success was defined as the resolution of signs and symptoms of disease and no further therapy required for CDAD as of the second day after cessation of fidaxomicin therapy. The recurrence of CDAD was defined by the reappearance of signs and symptoms of disease after the cessation of therapy, a new positive C. difficile polymerase chain reaction result, and the need for CDAD retreatment. Readmissions were tracked for 90 days after hospital discharge. RESULTS: Of the 60 patients who received fidaxomicin, 58 (96.7%) achieved clinical success. Twenty-six (43.3%) of the 60 patients were being treated for a second or greater episode. Six (10.3%) of the 58 patients had recurrence within 90 days after the initial treatment course, and 4 (6.9%) were readmitted within 30 days after hospital discharge. CONCLUSIONS: In this real-world setting, fidaxomicin resulted in a high rate of clinical success, a low rate of recurrence, and a low readmission rate.

Linezolid-induced lactic acidosis corrected with sustained low-efficiency dialysis: a case report.

Linezolid, an oxazolidinone antibiotic, has been reported to increase the risk of lactic acidosis and peripheral neuropathy because it disrupts mitochondrial function. This case report describes the development of lactic acidosis in a 63-year-old man who had received 3 months of treatment with intravenous linezolid for pulmonary nocardiasis, and correction of the acidotic state with sustained low-efficiency dialysis. This case demonstrates that renal replacement therapy can be an alternative to discontinuation alone for rapid reversal of linezolid-induced lactic acidosis.

Multicenter Cohort Study of Ceftaroline Versus Daptomycin for Treatment of Methicillin-Resistant Staphylococcus aureus Bloodstream Infection.

BACKGROUND: Observational data suggest ceftaroline may be effective for methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI), but comparative data with standard of care are limited. This analysis compares the outcomes of MRSA BSI treated with ceftaroline or daptomycin. METHODS: Multicenter, retrospective, observational cohort study of adult patients with MRSA BSI from 2010 to 2017. Patients treated with ≥72 hours of ceftaroline or daptomycin were included. Those clearing BSI before study drug and those with a pneumonia source were excluded. The primary outcome was composite treatment failure, defined as 30-day mortality, BSI duration ≥7 days on study drug, and 60-day MRSA BSI recurrence. Inverse probability of treatment weighted risk difference in composite failure between daptomycin and ceftaroline groups was computed and 15% noninferiority margin applied. RESULTS: Two hundred seventy patients were included; 83 ceftaroline and 187 daptomycin. Ceftaroline was noninferior to daptomycin with respect to composite failure (39% daptomycin, 32.5% ceftaroline; weighted risk difference, 7.0% [95% confidence interval, -5.0% to 19.0%]). No differences between treatment groups was observed for 30-day mortality or other secondary efficacy outcomes. Creatine phosphokinase elevation was significantly more common among daptomycin patients (5.3% vs 0%, P = .034). Rash was significantly more common among ceftaroline patients (10.8 vs 1.1%, P = .001). CONCLUSIONS: No difference in treatment failure or mortality was observed between MRSA BSI treated with ceftaroline or daptomycin. These data support future study of ceftaroline as a primary MRSA BSI treatment and current use of ceftaroline when an alternative to vancomycin and daptomycin is required.