Fecal Microbiota Transplantation for Refractory Clostridioides Difficile Infection Is Effective and Well Tolerated Even in Very Old Subjects: A Real-Life Study.

OBJECTIVES: Fecal microbiota transplantation (FMT) is an innovative therapy indicated for the treatment of recurrent Clostridioides difficile infections. Although CDI and its complications are more common in very old patients (≥80 years) due to their comorbidities, frailty and senescence of the immune system, limited data are available for this older patient population. DESIGN: This was a single-center, real-life cohort study with retrospective outcome data registration, conducted at Toulouse, France. SETTING AND PARTICIPANTS: Older people group was compared to the control group aged 18-79 years. MEASUREMENTS: The primary outcome was overall survival at 52 weeks for ≥80 years patients compared to the control group after FMT. Recurrence-free survival at 52 weeks and, the occurrence of adverse events in the short and long term were the secondary endpoints. RESULTS: A total of 58 patients were included, 19 were aged ≥80 years and 39 were aged 18-79 years. Overall survival at 52 weeks after FMT of the very old patients was not different from the control group (78.9% versus 89.7%, p= 0.29). Recurrence-free survival of CDI was not different between groups, with 94.3% in the 18-79-group versus 86.9% in the ≥80 group (p=0.44). The occurrence of short- or long-term adverse events was not statistically different between the two groups (36.8% vs 41%, p=0.45). CONCLUSIONS: FMT is effective and well-tolerated in very old frail patients. This treatment brings a rapid benefit and limits the loss of functions. It also favors their maintenance at home or in a non-medical institution dedicated to dependent subjects and improves their quality of life.

[Proper use of antibiotics: a prospective study on the use of linezolid in a French university hospital]. / Bon usage des antibiotiques: étude prospective sur l'utilisation du linézolide dans un hôpital universitaire français.

AIM OF THE STUDY: To describe clinical use of a new antibiotic: linezolid, in a French university hospital, on a population of patients different from the one studied during the clinical trials for the marketing authorisation. PATIENTS AND METHODS: An observational, prospective cohort study performed in patients treated by linezolid between November 2005 and June 2006 at Saint André hospital (Bordeaux University Hospital). The following data were collected: sources of infection, isolated pathogens, patient's background, antibiotherapy strategies, duration of therapy and evolution. RESULTS: Fifty patients (intensive care, internal medicine) were included. The absence of local guidelines on proper use of linezolid led to various prescriptions as well in infections listed in the marketing authorisation: nosocomial pneumonia and ventilator associated pneumonia (48%), skin and soft tissue infections (11%), as in endocarditis (7%), intra-abdominal infections (13%), bone and joint infections (2%), catheter infections (13%) and febrile neutropenic patients (6%). The main justification for using linezolid was worsening renal dysfunction (66%), which contra indicated glycopeptides use. Isolated pathogens were for the major part staphylococcus. CONCLUSION: In the context of proper use of antibiotics, it would be advisable to add new recommendations on the use of linezolid to the hospital's antibiotherapy guide which would constitute a tool for the prescribing clinicians, and to re-evaluate the impact during a second evaluation.