Posted in Flagyl on July 4, 2015

It is well-established that fidaxomicin reduces the recurrence rate of C. difficile infection (CDI), however this study from my old exploration group at GSTT / KCL is the capital to evaluate the impact of management with fidaxomicin on environmental contamination. The establish line is that patients treated with fidaxomicin had less C. difficile etc. see the verb than patients treated with vancomycin / metronidazole.

In integral, the rooms of 38 / 66 (57.6%) patients treated through metronidazole / vancomycin had one or besides positive environmental cultures compared with 25 / 68 (36.8%) patients treated by fidaxomicin (P = 0.02). Similarly, at the time considering all of the sampled environmental sites (four through room), 68 / 264 (25.8%) were confident in patients treated with metronidazole / vancomycin compared through 47 / 272 (17.3%) in patients treated through fidaxomicin (P = 0.02) (see Figure in the world of the departed).

Fidax CDI

Figure: Environmental contamination with C. difficile in the rooms of patients treated through fidaxomicin vs. vancomycin / metronidazole.

There are couple plausible mechanisms by which treatment by fidaxomicin would result in reduced environmental stain. One is through a shorter duration of symptoms. Another is through reduced shedding of spores for the period of symptoms. There was no difference in the PCR Ct excellence between the two groups, suggesting that the bacterial freight was not massively different, at in the smallest degree at the time the sample was taken. So, it seems in the greatest degree likely that a shorter duration of symptoms explains the reduced condition of environmental contamination. Whilst shorter lasting period of symptoms for patients on fidaxomicin has been reported previously, it was not measured in this study.

The study was not randomised; in the room, it was performed either side of a switch of face-line treatment for CDI from vancomycin / metronidazole to fidaxomicin. Thus, in that place could have been other changes that explained the bickering in contamination. But it’s significant to note that no changes to the cleaning / disinfection mode of management were made during this period, to such a degree this seems unlikely.

Curiously, 20-25% of the C. difficile isolated in the patient’s room did not union the ribotype of the current sweep occupant. It’s tempting to speak that this is leftover from the former room occupant, but the hospital uses phlogiston peroxide vapour (HPV) for terminal disinfection, in such a manner this seems unlikely. Perhaps these patients are infected by more than one ribotype? Or it’s imported into the room by healthcare workers? But the greatest in quantity likely source is from prior occupants who were not recognised to have ~ing infected or colonised with C. difficile, and whose rooms were not therefore decontaminated with HPV.

Another curiosity is the discovery that patients treated with fidaxomicin stayed in the hospital encompassing twice as long as those treated through vancomycin / metronidazole (median 26 v 12 days, p=0.01). Could it have ~ing that patients treated with vancomycin / metronidazole died greater quantity quickly / often? This seems unlikely seeing that there was no difference in altogether-cause 30-day mortality. So this remnants a mystery!

So patients treated by fidaxomicin have less C. difficile environmental pollution. Since admission to a room previously occupied by a patient with CDI is a dare to undertake factor for acquisition in the incoming holder, it seems likely that a higher adapt of contamination would increase this hazard further (for hospitals that are not using HPV). But a higher proportion of C. difficile environmental contamination is likewise important during the patient’s stay, after it likely increases the chances of contaminating cudgel hands and equipment.

Fidaxomicin is a great number more expensive than vancomycin / metronidazole, no more than this study (along with those showing not so much recurrence and shorter duration of symptoms) refer to that it is money well wearied.

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