How Often Are Bezlotoxumab and FMT Used in a Real-World Setting for CDI Recurrence?

Although bezlotoxumab and fecal microbiota transplantation (FMT) are efficacious for preventing Clostridioides difficile infection (CDI) recurrence, neither was commonly used in a real-world practice, according to a retrospective study published in Open Forum Infectious Diseases.

Patients (N=1377) with confirmed CDI were prospectively included in a hospital-specific database. For this study, the subset of patients who received bezlotoxumab (n=51) or FMT (n=49) were evaluated for the effectiveness of preventing recurrence of CDI. Early recurrence was defined as within 8 weeks of primary infection and late recurrence as within 1 year.

The bezlotoxumab and FMT recipients had a median age of 73 (IQR, 62-82) and 79 (IQR, 70-88) years; 62.7% and 69.4% were women; 66.7% and 18.4% were immunosuppressed (P <.001); 7.8% and 10.2% had inflammatory bowel disease; 35.3% and 0% were presenting with first-episode CDI (P <.01); and 45.0% and 20.4% had severe CDI (P =.01), respectively.

At 8 weeks, a total of 22 patients had CDI recurrence. The patients with early recurrence were more likely to have had 2 or more previous CDI recurrences (63.6% vs 41.0%; P =.05) and to have received non-CDI antibiotics after bezlotoxumab or FMT (50.0% vs 24.4%; P =.05) compared with those who did not have an early recurrence, respectively.

In the multivariate analysis, both non-CDI antibiotics following bezlotoxumab or FMT receipt (odds ratio [OR], 2.90; 95% CI, 1.03-8.63; P =.04) and 2 or more previous CDI recurrences (OR, 2.90; 95% CI, 1.03-8.63; P =.04) were associated with increased risk for early recurrence.

In a subgroup analysis, no significant group differences were observed for early recurrence rates.

The late recurrence rate was 18.4%.

A total of 10 patients died during the 1-year follow-up, 3 of which occurred in the first 3 weeks of treatment. Two of the deaths were attributed to CDI.

The limitations of this study include the significant differences in the patient groups at baseline and the small sample size.

This study of real-world data found that among patients with CDI at a university hospital, few received either bezlotoxumab or FMT. These treatments were associated with low recurrence rates, but patients who received non-CDI antibiotics and had a history of CDI recurrence were at higher risk for early recurrence.

“Our results are in concordance with previous publications and emphasize the need of preventive strategies for rCDI, including a close and specific antimicrobial stewardship intervention to avoid the use of inadequate antibiotics in these patients,” the study authors wrote.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the authors’ disclosures.