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Frequency of Clostridium difficile infection (CDI) transmission via ward contact with a known case Retrospective, observational study (22 months; 1 laboratory.

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Presentation on theme: "Frequency of Clostridium difficile infection (CDI) transmission via ward contact with a known case Retrospective, observational study (22 months; 1 laboratory."— Presentation transcript:

1 Frequency of Clostridium difficile infection (CDI) transmission via ward contact with a known case Retrospective, observational study (22 months; 1 laboratory providing diagnostic services for all inpatient and community care in Leeds, UK) Donor-recipient matching based on common ribotype and ward contact during defined infectious periods (7 days prior and ≤56 days after donor positive test) and incubation periods (≤90 before recipient positive test) Martin JSH. ECCMID 2013 abs. LB2963 Data from poster 1 of 2

2 Frequency of Clostridium difficile infection (CDI) transmission via ward contact with a known case Martin JSH. ECCMID 2013 abs. LB2963 Data from poster 2 of 2 Inpatient samples: Donor group: 75% - Recipient group: 78%

3 Impact of new liquid oxygen releaser surface disinfectant on risk of nosocomial Clostridium difficile infection (CDI) Single-centre before-after study (2 wards of internal medicine department of university hospital; Austria): –Pre-intervention phase: Conventional sporocidal surface disinfection; used only in response to occurrence of nosocomial CDI –Intervention phase: New liquid oxygen releaser disinfectant; used daily, regardless of CDI occurrence Hell M. ECCMID 2013 abs. O448 1 of 2

4 Impact of new liquid oxygen releaser surface disinfectant on risk of nosocomial Clostridium difficile infection (CDI) Daily use of a liquid oxygen releaser disinfectant may significantly reduce the incidence of nosocomial CDI compared with conventional disinfection 2 of 2 Hell M. ECCMID 2013 abs. O448

5 Effectiveness of donor faeces infusion for treating recurrent Clostridium difficile infection (CDI) Single-centre randomised controlled trial (2008-2010): N= 42 pts with recurrent CDI: –Group 1 (N=16): Initial vancomycin (500 mg orally 4x/day for 4 days) + bowel lavage + duodenal infusion of donor faeces through nasoduodenal tube (+ 2 nd infusion with donor faeces of different donor if no resolution of diarrhoea after 1 st infusion) –Group 2 (N=13): Standard vancomycin regimen (500 mg orally 4x/d for 14 d) –Group 3 (N=13): Standard vancomycin regimen (500 mg orally 4x/d for 14 d) + bowel lavage Primary endpoint: Resolution of diarrhoea without relapse after 10 wk Study was stopped after interim efficacy analysis No sign. ≠ in baseline characteristics between treatment groups van Nood E et al. N Engl J Med 2013;368:407-15 1 of 2

6 van Nood E et al. N Engl J Med 2013;368:407-15 2 of 2 Effectiveness of donor faeces infusion for treating recurrent Clostridium difficile infection (CDI)

7 Efficacy and safety of fidaxomicin vs vancomycin for Clostridium difficile infection: phase III non-inferiority trial Multi-centre, double-blind, randomised, non-inferiority trial (Europe, USA, Canada; 2007-2009) N= 535 pts with acute, toxin-positive C.difficile infection (CDI): –Fidaxomicin (FDX) (N=270): 200 mg orally every 12h for 10 days –Vancomycin (VCA)(N=265): 125 mg orally every 6h for 10 days 26 pts excluded; 509 pts included in modified intention-to-treat (mITT) population Safety (safety population: N=524) No significant differences in TEAEs between treatment groups Cornely OA et al. Lancet Infect Dis 2012;12:281-9 1 of 2 TEAE: treatment-emergent adverse event; * Possibly or definitely related to study drug

8 Efficacy Primary endpoint: Clinical cure = resolution of diarrhoea and no further need for treatment Tested hypothesis: FDX is non-inferior to VCA for primary endpoint; Criterion for non-inferiority: 1-sided lower 97.5% CI margin: -10% Subgroup analyses of primary endpoint in mITT population: no sign. ≠ Except: Efficacy and safety of fidaxomicin vs vancomycin for Clostridium difficile infection: phase III non-inferiority trial Fidaxomicin seems to be non-inferior to vancomycin for initial clinical response to CDI and seems to have a comparable safety profile Cornely OA et al. Lancet Infect Dis 2012;12:281-9 2 of 2


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