Clinical Scorecard: Preferences of Clinicians in Managing Adult Clostridioides difficile Infection: Insights from a 2024 Survey by the Emerging Infections Network
At a Glance
Category
Detail
Condition
Clostridioides difficile infection (CDI)
Key Mechanisms
Antimicrobial therapy targeting C. difficile and microbiome-based therapies to prevent recurrence
Target Population
Adults with initial or recurrent CDI
Care Setting
Infectious diseases clinical practice, primarily academic/university and outpatient settings in the United States
Key Highlights
Vancomycin remains the most frequently prescribed agent for initial, nonfulminant CDI (83% of clinicians).
Fidaxomicin is preferred by guidelines but limited by high cost and insurance coverage barriers.
New microbiome-based therapies (fecal microbiota live-jslm and spores live-brpk) are available but have limited access due to cost and logistics.
Guideline-Based Recommendations
Diagnosis
Diagnosis based on clinical presentation and laboratory confirmation of CDI.
Management
Fidaxomicin preferred over vancomycin for initial and recurrent CDI to reduce recurrence.
Vancomycin remains an acceptable alternative when fidaxomicin is not accessible.
Bezlotoxumab recommended as adjunctive therapy to reduce recurrence risk in patients with recent CDI episodes or other risk factors.
Fecal microbiota transplantation (FMT) and FDA-approved microbiome-based therapies (Rebyota, Vowst) recommended for prevention of recurrent CDI.
Monitoring & Follow-up
Monitor for CDI recurrence, especially within 6 months of prior episode.
Assess patient access and adherence to prescribed therapies.
Risks
High costs and insurance coverage challenges limit access to fidaxomicin and bezlotoxumab.
Limited availability and logistical challenges restrict use of FMT and newer microbiome therapies.
Patient & Prescribing Data
Adults with initial or recurrent CDI treated by infectious diseases clinicians in the US.
Vancomycin is most commonly prescribed despite guidelines favoring fidaxomicin; insurance and cost barriers limit fidaxomicin and bezlotoxumab use; FMT is recommended by most clinicians but access is limited.
Clinical Best Practices
Prioritize fidaxomicin for initial and recurrent CDI when accessible to reduce recurrence.
Use vancomycin as an effective alternative when fidaxomicin is not feasible.
Consider bezlotoxumab adjunctively in patients at high risk for recurrence.
Incorporate microbiome-based therapies including FMT and FDA-approved products for recurrent CDI prevention when available.
Address insurance and cost barriers proactively to improve patient access to recommended therapies.
