Health-related quality of life in patients with recurrent Clostridioides difficile infections

Abstract

Background: The health-related quality of life (HrQoL) can be substantially affected in patients with recurrent Clostridioides difficile infection (rCDI) but the impact of effective treatment of the infection remains unclear. This study aimed to evaluate the HrQoL in patients with rCDI and estimate the gain in HrQoL associated with effective treatment of rCDI. Methods: Patients’ HrQoL was estimated based on EuroQol 5-Dimensions 3-Levels (EQ-5D-3L) questionnaires obtained from a Danish randomised controlled trial (RCT). In the RCT, 64 patients with rCDI were randomised to receive either vancomycin ( n = 16), fidaxomicin ( n = 24) or faecal microbiota transplantation (FMT) preceded by vancomycin ( n = 24). The primary outcome in the RCT was rCDI resolution. Patients were closely monitored during the RCT, and rescue FMT was offered to those who failed their primary treatment. Patients’ HrQoL was measured at baseline and at 8- and 26-weeks follow-up. Linear regression analyses conditional on the differences between baseline and follow-up measurements were used to assess statistical significance ( p < 0.05). Results: Within 26 weeks of follow-up, 13 (81%) patients treated with vancomycin, 12 (50%) patients treated with fidaxomicin, and 3 (13%) patients treated with FMT had a subsequent recurrence and received a rescue FMT. The average HrQoL for untreated patients with rCDI was 0.675. After receiving effective treatment, this value increased by 0.139 to 0.813 ( p < 0.001) at week 8 and by 0.098 to 0.773 ( p = 0.003) at week 26 of follow-up compared with baseline. Conclusion: The HrQoL was adversely affected in patients with an active episode of rCDI but increased substantially after receiving an effective treatment algorithm in which rescue FMT was provided in case of a primary treatment failure. Trial registration: The RCT was preregistered at EudraCT (j.no. 2015-003004-24, https://www.clinicaltrialsregister.eu/ctr-search/trial/2015-003004-24/results ) and at ClinicalTrials.gov (study identifier NCT02743234, https://clinicaltrials.gov/ct2/show/NCT02743234 ).

Trasplante de microbiota fecal por colonoscopía en paciente mayor de 65 años con infección recurrente de Clostridioides difficile: aún una estrategia subutilizada

“…La ausencia de eventos adversos en nuestro paciente post-TMF muestra que esta es una estrategia válida en pacientes mayores de 65 años, tal como ha sido señalado en otra publicación nacional 13 . Recientemente, un estudio aleatorizado contralado mostró que el TMF mejora la calidad de vida de los pacientes con ICD recurrente 15 , situación que sucedió en nuestro paciente. Además, el TMF Trasplante de microbiota fecal en ifección recurrente por Clostridiodes difficile -P. Núñez et al sería una estrategia costo-efectiva al compararla con el tratamiento antimicrobiano, al prevenir de manera más eficaz los episodios de recurrencia 16 .…”

Fecal microbiota transplantation may reduce the mortality of patients with severe and fulminant Clostridioides difficile infection compared to standard‐of‐care antibiotics in a community hospital

“…Recently, fecal microbiota transplantation (FMT) has proved to be an effective therapy for recurrent and resistant CDI. It appears to be safe in short‐ and long‐term follow‐up, and provides a positive impact on the health‐related quality of life 1,2,6–10 . Several studies have suggested that FMT is a promising treatment for severe and fulminant CDI 11–16 .…”

“…It appears to be safe in short-and long-term follow-up, and provides a positive impact on the health-related quality of life. 1,2,[6][7][8][9][10] Several studies have suggested that FMT is a promising treatment for severe and fulminant CDI. [11][12][13][14][15][16] However, the impact of FMT on reducing the mortality of patients with severe and fulminant CDI has not been rigorously studied.…”

Vowst’s FDA approval is a boon for the prevention of recurrent Clostridioides difficile infection

“…In the USA, rCDI is a significant public health challenge, accounting for ~75 000–175 000 cases annually 5 , 7 . In addition to the economic burden on patients, an active episode of rCDI significantly impairs the quality of life of these patients 9 . All these mandates for effective prevention strategies to decrease the incidence of rCDI.…”