| Summary: | Background
Lower C. difficile spore counts in faeces from C. difficile infection (CDI) patients treated with fidaxomicin vs vancomycin have been observed. We aimed to determine if environmental contamination is lower in patients treated with fidaxomicin compared with those treated with vancomycin/metronidazole.
Methods
CDI cases were recruited at four UK hospitals (Leeds, Bradford, Londonx2). Environmental samples (five room sites) were taken pre-treatment, and at 2-3, 4-5, 6-8 and 9-12 days of treatment, end of treatment (EOT), and post-EOT. Faecal samples were collected at diagnosis and as often as produced thereafter. Swabs/ faeces were cultured for C. difficile; percentage of C. difficile positive samples and C. difficile bioburden were compared between different treatment arms at each time-point.
Results
Pre-EOT (n=244) there was a significant reduction in environmental contamination (≥ one site positive) around fidaxomicin vs vancomycin/metronidazole recipients at days 4-5 (30% vs 50% recipients, p=0.04), and at days 9-12 (22% vs 49%, p=0.005). This trend was consistently seen at all other timepoints, but was not statistically significant. No differences were seen between treatment groups post-EOT (n=76). Fidaxomicin-associated faecal positivity rates and colony counts were consistently lower than those for vancomycin/metronidazole from days 4-5 of treatment (including post-EOT); however, the only significant difference was in positivity rate at days 9-12 (15% vs 55%, p=0.03).
Conclusions
There were significant reductions in C. difficile recovery from both faeces and the environment around fidaxomicin vs vancomycin/metronidazole recipients. Fidaxomicin treatment may therefore lower the C. difficile transmission risk by reducing excretion and environmental contamination.
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