Bezlotoxumab was found to be associated with decreased risk for recurrent Clostridioides difficile infection (CDI) among patients having undergone solid organ or hematopoietic cell transplantation, according to the results of a study published in Open Forum Infectious Diseases.

This retrospective cohort study analyzed patient records from the University of Colorado Hospital collected between 2015 and 2019. Patients (N=95) who had undergone solid organ or hematopoietic cell transplantation were assessed for clinical characteristics and recurrent CDI.

The mean age of patients was 53±15 years, 56% were men, transplant occurred a median of 2.7 years (interquartile range [IQR], 0.4-7.5) previously, patients had history of 3 CDI infections (IQR, 2-3), and 39 (41%) had undergone treatment with bezlotoxumab. Transplants were of hematopoietic cells (n=21), kidney (n=27), liver (n=24), heart (n=11), lung (n=3), and multiple organs (n=8).

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Compared with those who did not undergo treatment with bezlotoxumab, fewer patients who were treated with bezlotoxumab were admitted to the intensive care unit (3% vs 21%; P =.01) or had severe CDI (13% vs 32%; P =.04). Bezlotoxumab was more frequently used as an extended, tapered CDI treatment (58% vs 23%; P <.01).

At 90 days, no significant differences were observed for CDI recurrence (16% vs 29%; P =.13), death (0% vs 5%; P =.27), hospital readmission (47% vs 50%; P =.67), or exacerbation of heart failure (0% vs 8%; P =.49) among the bezlotoxumab and standard-of-care cohorts, respectively.

Recurrence of CDI at 90 days was associated with number of previous CDI episodes (odds ratio [OR], 1.48; 95% CI, 1.12-1.95; P =.01) and bezlotoxumab exposure (OR, 0.28; 95% CI, 0.08-0.91; P =.03).

Bezlotoxumab was well tolerated among all but 1 patient, who had infusion-related nausea and discontinued use.

This study should be considered as exploratory as it was underpowered.

These data indicated use of bezlotoxumab was associated with decreased risk for CDI recurrence among patients who had undergone solid organ or hematopoietic cell transplantation.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Johnson TM, Howard AH, Miller MA, et al. Effectiveness of bezlotoxumab for prevention of recurrent Clostridioides difficile infection among transplant recipients. Open Forum Infect Dis. Published June 4, 2021. doi:10.1093/ofid/ofab294