, Volume 45, Issue 4, pp 425–431 | Cite as

Fidaxomicin for treatment of Clostridium difficile infection in clinical practice: a prospective cohort study in a French University Hospital

  • Marie Pichenot
  • Rozenn Héquette-Ruz
  • Remi Le Guern
  • Bruno Grandbastien
  • Clément Charlet
  • Frédéric Wallet
  • Sophie Schiettecatte
  • Fanny Loeuillet
  • Benoit Guery
  • Tatiana Galperine
Original Paper



Two randomized controlled trials (RCTs) showed the non-inferiority of fidaxomicin compared with vancomycin for Clostridium difficile infection (CDI) treatment and its superiority regarding recurrence rate. The aim of this study was to evaluate fidaxomicin’s efficacy in clinical practice.


This single-center prospective cohort study included hospitalized patients treated with fidaxomicin for CDI. Demographic, clinical and biological data were collected. Primary outcome was efficacy of fidaxomicin (clinical cure, recurrence and global cure) at 10 weeks. Secondary outcome was efficacy among different subgroups.


Ninety-nine patients were included: 42 severe CDI, 16 complicated CDI and 41 recurrent CDI. Rates of clinical cure, recurrence and global cure were 87, 15 and 59%, respectively. Subgroup analysis showed a higher recurrence rate for patients with recurrent CDI compared with first episode (8 vs. 26%; p = 0.04). Binary toxin was associated with severe/complicated CDI (80 vs. 50%; p < 0.01) and recurrence (32 vs. 7%; p < 0.01). Fidaxomicin was used as a first line for 83% of the patients with recurrence and for only 52% of first episodes even though 86% had recurrence’s risk factors.


Compared with RCTs, fidaxomicin in real world is used for patients with more severe and recurrent CDI, but clinical cure and recurrence rates were similar. Comparative studies are needed in these specific subgroups. Our data also illustrate clinicians’ difficulty to define a “patient at risk for recurrence” among the first episodes. Finally, we showed that binary toxin could be important in the screening for severity and recurrence risks.


Fidaxomicin Clostridium difficile Prospective Clinical practice 


Compliance with ethical standards

Conflict of interest

The authors decline conflicts of interest regarding this work and did not receive external funding.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Marie Pichenot
    • 1
  • Rozenn Héquette-Ruz
    • 1
  • Remi Le Guern
    • 2
  • Bruno Grandbastien
    • 2
  • Clément Charlet
    • 1
  • Frédéric Wallet
    • 3
  • Sophie Schiettecatte
    • 4
  • Fanny Loeuillet
    • 4
  • Benoit Guery
    • 1
    • 5
  • Tatiana Galperine
    • 1
  1. 1.Department of Infectious DiseasesUniversité Lille Nord de FranceLilleFrance
  2. 2.Department of Infection Risk ManagementUniversité Lille Nord de FranceLilleFrance
  3. 3.Institute of MicrobiologyUniversité Lille Nord de FranceLilleFrance
  4. 4.Department of PharmacyUniversité Lille Nord de FranceLilleFrance
  5. 5.Infectious Diseases Service, Centre Hospitalier Universitaire VaudoisUniversity of LausanneLausanneSwitzerland

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