Fidaxomicin monotherapy versus standard therapy combined with bezlotoxumab for treating patients with Clostridioides difficile infection at high risk of recurrence: a matched cohort study.

BACKGROUND: Both fidaxomicin and bezlotoxumab (used in combination with an antibiotic against Clostridioides difficile) achieve reductions in recurrence rates of C. difficile infection (CDI). However, the two strategies have never been compared. METHODS: Data from two retrospective cohorts of 'real-life' use of fidaxomicin and bezlotoxumab in combination with a standard anti-C. difficile antibiotic were used to compare the rates of recurrence of both strategies. Since the two cohorts were not identical, we used a propensity score analysis. RESULTS: Three hundred and two patients were included: 244 in the fidaxomicin cohort and 78 in the bezlotoxumab cohort. A history of renal failure or immunosuppression was more frequent in patients receiving bezlotoxumab (39.7% and 66.7% versus 26.6% and 38.9%; P = 0.03 and P < 0.001, respectively), but the severity and number of previous CDI episodes were similar in both cohorts. We observed that 19.3% of the patients in the fidaxomicin cohort experienced recurrence, compared with 14.1% in the bezlotoxumab cohort (OR 1.45; 95% CI 0.71-2.96; P = 0.29) but the difference remained non-significant after propensity score matching using previously defined variables (OR 1.24; 95% CI 0.50-3.07; P = 0.64). Moreover, the multivariate analysis did not show differences depending on the drug used. CONCLUSIONS: We observed that fidaxomicin and bezlotoxumab are prescribed in similar clinical scenarios, although those treated with bezlotoxumab have greater comorbidity. The proportion of recurrences was numerically lower in those treated with bezlotoxumab, although the propensity analysis did not find significant differences between the two drugs.

Etiology, diagnosis, and management of pneumonia in immunosuppressed patients

Patients with a compromised immune system suffer awide variety of insults. Pulmonary complications remain amajor cause of both morbidity and mortality in immunocompromised patients. When such individuals present with radiographic infiltrates, the clinician faces a diagnostic challenge.The differential diagnosis in this setting is broad and includesboth infectious and non-infectious conditions. Evaluation ofthe immunocompromised host with diffuse pulmonary infiltrates can be difficult, frustrating, and time-consuming. Thiscommon and serious problem results in significant morbidityand mortality, approaching 90%. Infections are the most common causes of both acute and chronic lung diseases leading torespiratory failure. Non-invasive diagnostic methods for evaluation are often of little value, and an invasive procedure (suchas bronchoalveolar lavage, transbronchial biopsy or even openlung biopsy) is therefore performed to obtain a microbiologicand histologic diagnosis. Bronchoscopy allows certain identification of some aetiologies, and often allows the exclusion ofinfectious agents. Early use of computed tomography scanning is able to demonstrate lesions missed by conventionalchest X-ray. However, even when a specific diagnosis is made,it might not impact patient’s overall survival and outcomes (AU)