Comparative effectiveness of early-targeted use of fidaxomicin versus oral vancomycin among hospitalized veterans' affairs patients with infections due to Clostridioides difficile

Study Objectives This study sought to compare real-world effectiveness outcomes between hospitalized patients with Clostridioides difficile infections (CDIs) who received early-targeted fidaxomicin or oral vancomycin at two Veterans Affairs Medical Centers (VAMCs). Design A retrospective cohort study was performed among hospitalized patients at two VAMCs from January 2008 until July 2017. Setting Albany and Syracuse VAMCs. Patients Patients were included in this analysis if they were age >= 18 years; were hospitalized; had a CDI with a Hines Severity Score Index (SSI) >= 2; received oral vancomycin (January 2008-June 2014 at Albany or Syracuse VAMCs) or fidaxomicin (March 2012-July 2017 at Albany VAMC) within 5 days of positive CDI stool sample for >= 48 hours. Intervention Receipt of an oral vancomycin- or fidaxomicin-containing CDI regimen. Measurements The primary outcome was a composite of 30-day mortality and 60-day recurrence. Main Results The study included 54 oral vancomycin and 38 fidaxomicin recipients. The population was predominantly male (97.8%), and mean +/- standard deviation age was 74.6 +/- 11.1 years. The composite outcome was significantly different between fidaxomicin and vancomycin recipients (26.3% fidaxomicin vs. 51.9% vancomycin; odds ratio (OR): 0.33, 95% CI: 0.14-0.81, p = 0.01). This finding was maintained in the multivariate analysis after adjustment for confounders (adjusted OR: 0.25, 95% CI: 0.09-0.73, p = 0.01) Conclusions This real-world effectiveness study suggests that use of fidaxomicin potentially results in better outcomes relative to oral vancomycin for initial treatment of hospitalized VAMC patients with CDIs.