{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T02:23:50Z","timestamp":1787192630447,"version":"build-2736575974"},"reference-count":50,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n \n Recent European Society of Clinical Microbiology and Infection and Australasian Society of Infectious Diseases\n Clostridioides difficile<\/jats:italic>\n infection (CDI) management guidelines endorse the addition of intravenous tigecycline in patients who are progressing to fulminant infection. However, there are very limited data regarding clinical outcomes with this approach.\n <\/jats:p>\n <\/jats:sec>\n \n Aims<\/jats:title>\n We aimed to evaluate mortality and adverse outcomes after tigecycline combination therapy was commenced at the time of fulminant CDI.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This retrospective single\u2010site observational study included patients between January 2018 and December 2022 treated with adjunctive intravenous tigecycline for fulminant CDI in addition to oral vancomycin and intravenous metronidazole. The primary outcome was all\u2010cause mortality at 30\u2009days. Secondary outcomes included clinical cure, partial response, in\u2010hospital CDI\u2010attributable and 90\u2010day all\u2010cause mortality, colectomy and adverse events.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Eighteen patient episodes occurred, with median age 67.5\u2009years, requiring intensive care admission and inotropic support in 66.7% and 50% of episodes respectively. All\u2010cause mortality at 30\u2009days was 22.2%. Clinical cure occurred at 14\u2009days in 16.7% of cases and partial response requiring further oral therapy in 55.6%. There was one colectomy and two serious adverse events, including a hyperkalaemic cardiac arrest in a haemodialysis patient and one significant intra\u2010abdominal bleeding episode requiring surgery.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Tigecycline combination therapy resulted in improved all\u2010cause 30\u2010day mortality in high\u2010risk CDI patients versus historical data, without the use of faecal microbiota transplantation. Poor outcomes were seen in three patients with pre\u2010existing renal failure, and we question the efficacy and safety of tigecycline in this group. This is a useful salvage strategy, but monitoring for toxicity is essential.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/imj.70603","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T01:34:32Z","timestamp":1787189672000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Tigecycline combination therapy for fulminant\n Clostridioides difficile<\/i>\n infection: an Australian experience"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5011-1660","authenticated-orcid":false,"given":"Emma","family":"Bishop","sequence":"first","affiliation":[{"name":"Infection Program, Monash Biomedicine Discovery Institute and Department of Microbiology Monash University Melbourne Victoria Australia"},{"name":"Department of Infectious Diseases Peninsula Health Melbourne Victoria Australia"},{"name":"Peninsula Clinical School Monash University Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4716-6718","authenticated-orcid":false,"given":"Tanya","family":"Ravipati","sequence":"additional","affiliation":[{"name":"National Centre for Healthy Ageing Monash University and Peninsula Health Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2599-8957","authenticated-orcid":false,"given":"Steven","family":"Mileto","sequence":"additional","affiliation":[{"name":"Infection Program, Monash Biomedicine Discovery Institute and Department of Microbiology Monash University Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugene","family":"Athan","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Barwon Health Geelong Victoria Australia"},{"name":"Barwon Southwest Public Health Unit Barwon Health Geelong Victoria Australia"},{"name":"Centre for Innovation in Infectious Disease and Immunology Research Deakin University Geelong Victoria Australia"},{"name":"School of Medicine Deakin University Geelong Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dena","family":"Lyras","sequence":"additional","affiliation":[{"name":"Infection Program, Monash Biomedicine Discovery Institute and Department of Microbiology Monash University Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3800-902X","authenticated-orcid":false,"given":"Ravindranath","family":"Tiruvoipati","sequence":"additional","affiliation":[{"name":"Peninsula Clinical School Monash University Melbourne Victoria Australia"},{"name":"Department of Intensive Care Medicine Peninsula Health Melbourne Victoria Australia"},{"name":"Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"crossref","first-page":"2234","DOI":"10.1016\/j.cgh.2019.12.029","article-title":"Fecal microbiota transplant decreases mortality in patients with refractory severe or fulminant Clostridioides difficile infection","volume":"18","author":"Cheng YW","year":"2020","journal-title":"Clin Gastroenterol Hepatol"},{"key":"e_1_2_8_3_1","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1001\/archsurg.2009.51","article-title":"Fulminant Clostridium difficile colitis: patterns of care and predictors of mortality","volume":"144","author":"Sailhamer EA","year":"2009","journal-title":"Arch Surg"},{"key":"e_1_2_8_4_1","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/j.cmi.2024.09.017","article-title":"Which trials do we need? 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