Tag Archives: C.difficile Ribotype 027

Study Investigators Find Combination of Vancomycin and FMT Superior In Treating Recurrent C.difficile Infection (rCDI)

The combination of vancomycin and fecal microbiota transplantation was found to be superior to fidaxomicin or vancomycin in the treatment of patients with recurrent Clostridium difficile infection (rCDI), according to a study published in Gastroenterology.

This randomized, single-center trial was designed to compare the efficacy of fecal microbiota transplantation with that of fidaxomicin and vancomycin.

Sixty-four adults with recurrent CDI seen at a gastroenterology clinic in Denmark between April 5, 2016 and June 10, 2018 were randomly assigned to a group receiving fecal microbiota transplantation applied by colonoscopy or nasojejunal tube after 4 to 10 days of 125 mg vancomycin 4 times daily (n=24), or 10 days of 200 mg fidaxomicin 2 times daily (n=24), or 10 days of 125 mg vancomycin 4 times daily (n=16).

Patients experiencing a CDI recurrence after this course of treatment, and those who could not be randomly assigned were provided rescue fecal microbiota transplantation. The primary study outcome was combined clinical resolution and negative polymerase chain reaction test for C difficile toxin at 8 weeks post-treatment, and secondary end points included week 8 clinical resolution.

The combination of negative C difficile test results and clinical resolution was observed in 71% of the 24 participants who received fecal microbiota transplantation (95% CI, 49-87%; n=17), 33% of the 24 participants who received fidaxomicin (95% CI, 16-55%; n=8), and 19% of the 16 participants (95% CI, 5-46%; n=3) who received vancomycin (fecal microbiota transplantation vs fidaxomicinP=.009; fecal microbiota transplantation vs vancomycin, P=.001; fidaxomicin vs vancomycin, P=.31). Clinical resolution was observed in 92% of participants who received fecal microbiota transplantation (n=22; P=.0002), 42% of participants who were treated with fidaxomicin (n=10; <.0001), and 19% of participants who were treated with vancomycin (n=3; P=.13). No significant differences in results were seen between patients receiving initial fecal microbiota transplantation therapy and those who received rescue treatment with such a transplant.

Of note, adverse events (transient abdominal pain, constipation, bloating and diarrhea) were observed in 10 of the participants who received a fecal microbiota transplant, 1 of which was classified as severe.

Researchers noted limitation of a lack of patients with C difficile ribotype 027, such that results may not be generalizable to settings with a high ribotype 027 frequency. Study interventions were also unblinded, introducing the possibility of observer bias, although the C difficile toxin test was applied to all patients at all time points in an effort to obtain objective outcome measures.

Study investigators concluded, “[fecal microbiota transplantation] was superior to both fidaxomicin and vancomycin monotherapies for [recurrent] CDI, with regard to both combined clinical and microbiological resolution and clinical resolution alone.”

Reference

https://www.infectiousdiseaseadvisor.com/respiratory/new-powder-formulation-tuberculosis-vaccine-candidate-is-in-human-trial/article/829508/

Hvas CL, Jørgensen SMD, Jørgensen SP, et al. Fecal microbiota transplantation is superior to fidaxomicin for treatment of recurrent Clostridium difficile infection [published online January 2, 2019]. Gastroenterology. doi: 10.1053/j.gastro.2018.12.019

Recent Emergence of C.difficile Infection in Romanian Hospitals – Abstract

Recent Emergence of Clostridium Difficile Infection in Romanian Hospitals is Associated With a High Prevalence of Polymerase Chain Reaction Ribotype 027.

Abstract

AIMS:

To evaluate the epidemiology of Clostridium difficile infection in several Romanian hospitals.

METHODS:

A survey was conducted from November 2013 to February 2014 in 9 hospitals selected from different Romanian regions.

RESULT:

The survey identified 393 patients with C. difficile infection. The median age was 67 years (range: 2-94 years) with 56% of patients older than 65 years. The mean C. difficile infection prevalence was 5.2 per 10.000 patient-days, with the highest prevalence, 24.9 and 20 per 10.000 patients-days, reported in a gastroenterology and an infectious diseases hospital, respectively. The origin of C. difficile infection was health care-associated for 70.5% of the patients, community-acquired for 10.2% of patients and indeterminate for other 19.3%. Severe C. difficile infection was registred in 12.3% cases and in hospital all-cause mortality was 8.8%. Polymerase chain reaction-ribotype 027 was the most prevalent in all participating hospitals, and represented 82.6% of the total ribotyped isolates. Moxifloxacin minimal inhibitory concentrations were higher than 4 μg/mL for 59 of 80 tested isolates (73.8%). Fifty-four of these 59 isolates were highly resistant to moxifloxacin, (minimal inhibitory concentration ≥32 μg/mL) and belonged more frequently to polymerase chain reaction-ribotype 027 (p<0.0001).

CONCLUSION:

The present study is the first multicentre study performed in Romania and shows that the ribotype 027 is largely predominant in C. difficile infection cases in Romania. The prevalence of C. difficile infection in some specialized hospitals is higher than the European mean prevalence and demonstrates the need of strict adherence to infection control programmes.

 

https://www.ncbi.nlm.nih.gov/pubmed/29188783?dopt=Abstract&utm_source=dlvr.it&utm_medium=twitter