Bezlotoxumab for prevention of Clostridium difficile infection recurrence: Distinguishing relapse from reinfection with whole genome sequencing

作者：Zeng, Zhen; Zhao, Hailong; Dorr, Mary Beth; Shen, Judong; Wilcox, Mark H.; Poxton, Ian R.; Guris, Dalya; Li, Junhua; Shaw, Peter M.^*

来源：Anaerobe, 2020, 61: 102137.

DOI：10.1016/j.anaerobe.2019.102137

• Bezlotoxumab
• Clostridium difficile infection
• Recurrence
• Reinfection
• Relapse
• Single nucleotide polymorphism
• Whole genome sequencing

Background: Bezlotoxumab has been shown to prevent Clostridium difficile infection recurrence (rCDI) in high-risk patients. @@@ Methods: We used whole genome sequencing to estimate the impact of bezlotoxumab on same-strain relapse or new-strain reinfection in MODIFY I/II trials. Reinfection with a new strain and relapse with the same strain were differentiated by the comparison of ribotype (RT) and pair-wise single-nucleotide whole genome sequencing (WGS) variations (PWSNV). Relapse was assigned if the baseline RT and the RT isolated during rCDI were the same, and if PWSNVs were <= 2. Reinfection was assigned if the baseline RT and the RT isolated during rCDI were different, or if the RT was the same but PWSNVs were > 10. Unknown status was assigned if the RT was the same but PWSNVs were 3-10. @@@ Results: 259 rCDI events were evaluable (50 [19.3%] reinfection; 198 [76.4%] relapse). The proportion of relapses was higher for ribotype 027 (84.5%) compared with other ribotypes (74.1%). Cumulative incidence of relapse was significantly lower for bezlotoxumab versus no bezlotoxumab (p <0.0001), with a non-significant trend towards reduction for reinfection (p = 0.14). @@@ Conclusion: Bezlotoxumab treatment significantly reduced the rate of CDI relapse versus a regimen without bezlotoxumab.

• 单位
  深圳华大基因研究院