Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:45pm
Presentation Time: 4:15pm-4:27pm
*Purpose: Clostridioides difficile is an urgent health threat associated with significant morbidity and mortality. Recipients of solid organ (SOT) and hematopoietic-cell transplantations (HCT) are at high risk for Clostridioides difficile infection (CDI), particularly recurrent disease. Bezlotoxumab (BEZ) was approved in 2016 for prevention of CDI recurrence; however, insufficient data exists regarding its use among SOT and HCT recipients. We sought to evaluate the effectiveness of BEZ among transplant recipients at our institution.
*Methods: We performed a retrospective analysis at our institution comparing SOT or HCT recipients who received BEZ to historic controls without BEZ receipt between January 2017 and June 2019. Controls were matched 2:1 based on transplant receipt, prior CDI episodes and concomitant receipt of broad-spectrum antibiotics. Primary outcome was 90-day CDI recurrence. Secondary outcomes included hospital readmission, mortality, and safety.
*Results: Among 47 BEZ recipients, 27 (57%) were transplant recipients (89% SOT & 11% HCT). A total of 54 controls were identified for comparison, 67% SOT (p=0.03) and 33% HCT (p=0.03). Baseline characteristics were similar for BEZ and control groups: median Charlson Comorbidity Index score (IQR) 4 (2, 6) versus 4 (2, 6), median number of lifetime CDI episodes (IQR) 3 (1, 4) versus 3 (2, 4), presence of severe CDI 15% versus 32%, concomitant broad-spectrum antibiotic use 70% versus 67%, fecal transplant receipt 19% versus 9%, and extended duration of anti-CDI antibiotics beyond 14 days 82% versus 65% respectively. Oral vancomycin was the predominant anti-CDI treatment of choice, 89% for both groups. Recurrence of CDI at 90 days was 19% for BEZ and 30% for control (OR 0.54; 95% CI, 0.17-1.68, p=0.29). All-cause 90-day mortality and hospital readmission was not significantly different for BEZ and control groups, 0 versus 6% and 52% versus 63% respectively. For those with prior CDI history, 90-day recurrence was 24% BEZ vs. 45% controls (p=0.15). BEZ was well tolerated, and there were no heart failure exacerbations among BEZ recipients and 2 exacerbations identified from control group.
*Conclusions: BEZ use in high-risk transplant recipients was associated with a non-significant reduction in CDI recurrence at 90-days. Our analysis was limited by small numbers and significant number of both BEZ recipients and controls receiving extended duration of anti-CDI antibiotics, which could have contributed to inability to show a statistical difference in recurrence. Further studies are needed to determine the true impact of BEZ on prevention of recurrent CDI in this high-risk group of patients.
To cite this abstract in AMA style:Bajrovic V, Johnson T, Howard A, Allen L, Barber G, Schwarz K, Huang M, Abidi M, Benamu E, Ramanan P, Miller M. Effectiveness of Bezlotoxumab for Prevention of Recurrent Clostridioides Difficile Infection among Transplant Recipients [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/effectiveness-of-bezlotoxumab-for-prevention-of-recurrent-clostridioides-difficile-infection-among-transplant-recipients/. Accessed October 28, 2020.
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