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Redefining Clostridioides difficile infection antibiotic response and clinical outcomes - 29/06/23

Doi : 10.1016/S1473-3099(23)00047-6 
Anne J Gonzales-Luna, PharmD a, Andrew M Skinner, MD b, c, Carolyn D Alonso, MD d, Emilio Bouza, ProfMD f, Oliver A Cornely, ProfMD g, h, i, j, Tim G J de Meij, MD k, Richard J Drew, MD l, m, n, Kevin W Garey, ProfPharmD a, Dale N Gerding, ProfMD c, Stuart Johnson, ProfMD c, Stacy A Kahn, MD o, Haru Kato, MD q, Ciaran P Kelly, ProfMD e, Colleen R Kelly, MD r, Larry K Kociolek, MD s, Ed J Kuijper, ProfMD t, y, Thomas Louie, ProfMD u, Thomas V Riley, ProfPhD v, Thomas J Sandora, MD p, Maria J G T Vehreschild, ProfMD w, Mark H Wilcox, ProfMD x, y, Erik R Dubberke, Prof y,

The EXPAND Cdiff group

a Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, USA 
b Department of Medicine, Loyola University Medical Center, Maywood, IL, USA 
c Department of Medicine and Department of Research, Edward Hines Jr Veterans Administration Hospital, Hines, IL, USA 
d Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA 
e Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA 
f Department of Microbiology and Infectious Diseases, Universidad Complutense, Madrid, Spain 
g Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Disease, Translational Research, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany 
h Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf and Excellence Center for Medical Mycology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany 
i Clinical Trials Centre Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany 
j German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany 
k Department of Pediatric Gastroenterology, Emma Children’s Hospital, Amsterdam University Medical Centers, Amsterdam, Netherlands 
l Clinical Innovation Unit, Rotunda Hospital and Children’s Health Ireland, Dublin, Ireland 
m Irish Meningitis and Sepsis Reference Laboratory, Children’s Health Ireland at Temple Street, Dublin, Ireland 
n Department of Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland 
o Division of Gastroenterology, Hepatology & Nutrition, Boston Children’s Hospital, Boston, MA, USA 
p Department of Pediatrics, Boston Children’s Hospital, Boston, MA, USA 
q Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Tokyo, Japan 
r Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA 
s Division of Pediatric Infectious Diseases, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, USA 
t Department of Medical Microbiology, Leiden University Medical Centre, Leiden, Netherlands 
u Infectious Diseases, Department of Medicine, University of Calgary, Calgary, AB, Canada 
v School of Biomedical Sciences, The University of Western Australia, Crawley, WA, Australia 
w Infectious Diseases, Department of Internal Medicine, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany 
x Microbiology, Old Medical School, Leeds General Infirmary, Leeds, UK 
y European Society of Clinical Microbiology and Infectious Diseases Study Group for Clostridioides difficile, Basel, Switzerland 

* Correspondence to: Prof Erik R Dubberke, Division of Infectious Diseases, Washington University School of Medicine, St Louis, MO 63110, USA Division of Infectious Diseases Washington University School of Medicine St Louis MO 63110 USA

Summary

With the approval and development of narrow-spectrum antibiotics for the treatment of Clostridioides difficile infection (CDI), the primary endpoint for treatment success of CDI antibiotic treatment trials has shifted from treatment response at end of therapy to sustained response 30 days after completed therapy. The current definition of a successful response to treatment (three or fewer unformed bowel movements [UBMs] per day for 1–2 days) has not been validated, does not reflect CDI management, and could impair assessments for successful treatment at 30 days. We propose new definitions to optimise trial design to assess sustained response. Primarily, we suggest that the initial response at the end of treatment be defined as (1) three or fewer UBMs per day, (2) a reduction in UBMs of more than 50% per day, (3) a decrease in stool volume of more than 75% for those with ostomy, or (4) attainment of bowel movements of Bristol Stool Form Scale types 1–4, on average, by day 2 after completion of primary CDI therapy (ie, assessed on day 11 and day 12 of a 10-day treatment course) and following an investigator determination that CDI treatment can be ceased.

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Vol 23 - N° 7

P. e259-e265 - luglio 2023 Ritorno al numero
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