Open Forum Infect Dis

Fidaxomicin cuts C. diff recurrence in immunocompromised patients

February 26, 2026

A large retrospective cohort study of 11,204 adults (including 2,362 immunocompromised patients) found that fidaxomicin significantly reduced Clostridioides difficile infection (CDI) recurrence compared with oral vancomycin. Recurrence occurred in 8% of fidaxomicin-treated immunocompromised patients vs. 17% of those treated with vancomycin (P = 0.019). Multivariable analysis confirmed a 56% lower adjusted odds of recurrence with fidaxomicin (adjusted odd ratio [aOR], 0.44, 95% confidence interval [CI], 0.21–0.96). Despite no statistically significant difference in the composite outcome of recurrence, 90‑day mortality, and colectomy (aOR, 0.65; 95% CI, 0.39–1.07; P = 0.09), the recurrence reduction alone represents a meaningful clinical benefit for this high‑risk group. Older age, recent antibiotic exposure, and hypoalbuminemia were independently associated with poorer outcomes.

Clinical takeaway: When treating an initial episode of CDI in immunocompromised adults, consider fidaxomicin as first‑line therapy to meaningfully reduce recurrence risk and improve patient outcomes.

Source:

Atamna A, et al. (2025, December 11). Open Forum Infect Dis. Fidaxomicin for Initial Episode of Clostridioides difficile Infection Reduces Recurrence in Immunocompromised Hosts-a Large Retrospective Cohort Study. https://pubmed.ncbi.nlm.nih.gov/41439186/