The impact of the introduction of fidaxomicin on the management of Clostridium difficile infection in 7 NHS secondary care hospitals in England: a series of local service evaluations

Purpose. C. difficile infection (CDI) is associated with high mortality. Reducing incidence is a priority for patients, clinicians, the NHS and Public Health England alike. In June 2012 fidaxomicin (FDX) was launched for the treatment of adults with CDI. The objective of this evaluation was to collect robust real world data to understand the effectiveness of fidaxomicin in routine practice. Methods. In 7 hospitals introducing FDX between July 2012-July 2013, data were collected retrospectively from medical records on CDI episodes occurring 12 months before/after the introduction of FDX. All hospitalised patients aged ≥18yrs with primary CDI (diarrhoea with presence of toxin A/B without a previous CDI in the previous 3 months) were included. Recurrence was defined as in-patient diarrhoea re-emergence requiring treatment anytime within 3 months after the first episode. Results. Each hospital had a different protocol for use of fidaxomicin. In hospitals A and B, where fidaxomicin was used first line for all primary and recurrent episodes, recurrence rate reduced from 10.6% to 3.1% and from 16.3% to 3.1%, with a significant difference in 28-day mortality from 18.2% to 3.1% (P<0.04) and 17.3% to 6.3% (P<0.04) for hospital A and B respectively. In hospitals using fidaxomicin in selected patients only, the changes in recurrence rates and mortality were less marked. Conclusions. The pattern of adoption of FDX appears to affect its impact on CDI outcome with maximum reduction in recurrence and all-cause mortality where used as first line.