Bezlotoxumab for prevention of Clostridioides difficile recurrence in patients with inflammatory bowel disease: a retrospective multicenter experience

Abstract

Background Bezlotoxumab can reduce recurrent Clostridioides difficile infection (rCDI); however, data from patients with inflammatory bowel disease (IBD) are limited. Since rCDI is common in IBD, we assessed the efficacy of bezlotoxumab for rCDI prevention in patients with and without IBD.

Methods Adults who received bezlotoxumab for CDI were identified. Clinical variables and adverse events were collected during a minimum follow-up of 1 year. The primary outcome was rCDI, classified at 4 time intervals (30, 60, 90 days, and 1 year).

Results Of the 70 patients identified, 34 patients had IBD. Most patients (88.6%) had ≥2 prior CDI episodes (interquartile range [IQR] 1-4). Bezlotoxumab was commonly combined with vancomycin (61.4%) or fidaxomicin (42.9%), which did not differ between patients with and without IBD. Following bezlotoxumab, the 1-year rCDI rate was 28.6% (median 65 days, IQR 32.8-158.3), while the 30-, 60- and 90-day rCDI rates were 5.7%, 12.9% and 22.9%, respectively. Patients with IBD had comparable rCDI rates to non-IBD patients, including at 30 (5.9% vs. 5.6%, P>0.99), 60 (17.6% vs. 8.3%, P=0.30), and 90 days (20.6% vs. 13.9%, P=0.54), and 1 year (32.4% vs. 25.0%, P=0.60). A history of colorectal surgery or vancomycin exposure was more common among patients with IBD and rCDI. Adverse events occurred in 6 patients (8.6%), most commonly heart failure exacerbation.

Conclusions The rCDI rate following bezlotoxumab was similar in patients with and without IBD. In patients with IBD, a history of colorectal surgery or prior vancomycin exposure was more common among those who experienced rCDI.

Keywords Inflammatory bowel disease, bezlotoxumab, recurrent Clostridioides difficile infection

Ann Gastroenterol 2026; 39 (1): 114-122