Patients with inflammatory bowel disease (IBD) who develop Clostridioides difficile infection (CDI) are at increased risk for adverse outcomes. This study aimed to assess the efficacy and safety of fidaxomicin in treating CDI among IBD patients in an international cohort.

This was a multicentric retrospective study including 96 adult patients with ulcerative colitis (57, 59%) or Crohn’s disease (39, 41%) from 20 IBD centres, treated with fidaxomicin for confirmed CDI. Most patients were under advanced medical therapy for IBD (70, 73%). A first episode of CDI was documented in 46 patients (48%), while the remainder had recurrent infection. Approximately one-third of the patients had at least one additional risk factor for CDI, such as recent hospitalisation, antibiotic exposure, or proton pump inhibitor use.

The CDI recurrence rate was 10% at 8 weeks, and the sustained clinical response rate was 82% at 12 weeks. Patients with a first episode of CDI had a lower recurrence rate (4.3% vs. 16%; p=0.06) and a higher rate of sustained response (91% vs. 75%; p=0.04). Escalation of IBD therapy was required in nearly half of the patients at 180 days, with a trend towards reduced need among those who achieved a sustained CDI response (12% vs. 20%; p=0.42). Five patients with ulcerative colitis underwent colectomy. One death was recorded, unrelated to CDI or IBD.

Thus, fidaxomicin proved to be effective and safe for the treatment of CDI in patients with IBD, particularly in initial episodes, with low recurrence rates and potential short-term benefit on IBD outcomes.