Tag Archives: Vancomycin Treating C. diff.

First Isolation of C.diff. PCR Ribotype 027 and Epidemiological Research of CDI in Hospitalized Adults In Tongji Hospital, Central China


Author Information: Zhou Y1, Mao L2, Yu J2, Lin Q2, Luo Y2, Zhu X3, Sun Z4.


Clostridium difficile infection (CDI) is an emerging healthcare problem in the world. The purpose of this study was to perform a systematic epidemiological research of CDI in Tongji hospital, the central of China.


Stool samples from hospitalized adults suspected of CDI were enrolled. The diagnosis of CDI were based on the combination of clinical symptoms and laboratory results. Clinical features of CDI and non-CDI patients were compared by appropriate statistical tests to determine the risk factors of CDI. Multilocus sequence typing (MLST) was employed for molecular epidemiological analysis. Susceptibility testing and relevant antimicrobial agent resistance genes were performed as well.


From June 2016 to September 2017, 839 hospitalized adults were enrolled. Among them, 107 (12.8%, 107/839) patients were C. difficile culture positive, and 73 (8.7%, 73/839) were infected with toxigenic C. difficile (TCD), with tcdA + tcdB+ strains accounting for 90.4% (66/73) and tcdA-tcdB+ for 9.6% (7/73). Meanwhile, two TCD strains were binary toxin positive and one of them was finally identified as CD027. Severe symptoms were observed in these two cases. Multivariate analysis indicated antibiotic exposure (p = 0.001, OR = 5.035) and kidney disease (p = 0.015, OR = 8.329) significantly increased the risk of CDI. Phylogenetic tree analysis demonstrated 21 different STs, including one new ST (ST467); and the most dominant type was ST54 (35.6%, 26/73). Multidrug-resistant (MDR) TCD were 53.4% (39/73); resistance to ciprofloxacin, erythromycin, and clindamycin were > 50%. Other antibiotics showed relative efficiency and all strains were susceptible to metronidazole and vancomycin. All moxifloxacin-resistant isolates carried a mutation in GyrA (Thr82 → Ile), with one both having mutation in GyrB (Ser366 → Ala).


Knowledge of epidemiological information for CDI is limited in China. Our finding indicated tcdA + tcdB+ C. difficile strains were the dominant for CDI in our hospital. Significant risk factors for CDI in our setting appeared to be antibiotic exposure and kidney disease. Metronidazole and vancomycin were still effective for CDI. Although no outbreak was observed, the first isolation of CD027 in center China implied the potential spread of this hypervirulent clone. Further studies are needed to enhance our understanding of the epidemiology of CDI in China.

Source:  https://www.ncbi.nlm.nih.gov/pubmed/30845918?dopt=Abstract&utm_source=dlvr.it&utm_medium=twitter

Clostridium difficile Treatment Strategies

Authors: Teena Chopra, Ellie J.C. Goldstein, Sherwood L. Gorbach

  • First published: 20 December 2016 Full publication history
  • DOI: 10.1002/phar.1863View/save citation
  • Funding: This work was supported by Merck & Co., Inc., Kenilworth, New Jersey.
  • Disclosures: T.C. served as a speaker for Pfizer Inc., Merck & Co., Inc., Cubist Pharmaceuticals, Inc., and Actavis, plc. E.J.C.G. has participated in advisory boards sponsored by Merck & Co., Inc., Cubist Pharmaceuticals, Inc., Optimer Pharmaceuticals, Inc., Bayer AG, Bio-K Plus International, Inc., Summit Therapeutics, plc, Kindred Healthcare, Inc., Novartis Pharmaceuticals Corporation, Daiichi Sankyo Company, Ltd., and Rempex Pharmaceuticals, Inc. He has served as a speaker for Bayer AG, Merck & Co., Inc., Forest Laboratories, Inc., Optimer Pharmaceuticals, Inc., and Cubist Pharmaceuticals, Inc.; he has received research grants from Merck and Co., Inc., Schering-Plough Pharmaceuticals, LLC, Optimer Pharmaceuticals, Inc., Theravance Biopharma, Cubist Pharmaceuticals, Inc., Pfizer, Inc., Astellas Pharma US, Inc., Cerexa, Inc., Forest Laboratories, Inc., Impax Laboratories, Inc., Novartis Pharmaceuticals Corporation, Clinical Microbiology Institute, Genzyme Corporation, a Sanofi company, Nano Pacific Holdings, Inc., Romark Laboratories, LC, ViroXis Corp., Warner Chilcott, plc, AvidBiotics Corp., GLSynthesis, Inc., Immunome, Inc., Salix Pharmaceuticals, Inc., Summit Therapeutics, plc, GlaxoSmithKline plc, Rempex Pharmaceuticals, Inc., Symbiomix Therapeutics, Gynuity Health Projects, Durata Therapeutics, Inc., and Toltec Pharmaceuticals, LLC. S.L.G. has served as a consultant for Seres Therapeutics, Inc., Medimmune, LLC, and Cempra Pharmaceuticals. He was also a consultant for Cubist Pharmaceuticals, now Merck & Co, Inc., at the time that the manuscript was written.


In recent years, Clostridium difficile infection (CDI) has become a global public health threat associated with increased morbidity, mortality, and economic burden, all of which are exacerbated with disease recurrence. Current guidelines informing treatment decisions are largely based on definitions of disease severity at diagnosis, with subjective components not well delineated across treatment algorithms and clinical trials. Furthermore, there is little evidence linking severity at onset to outcome. However, reducing the risk of recurrence may offer both a better outcome for the individual and decreased downstream economic impact.

The authors present data supporting the opinion that patients deemed at low risk for recurrence should receive vancomycin (or metronidazole when cost is an issue), while those at higher risk of recurrence would benefit from fidaxomicin treatment.

Although further prospective studies are needed, choosing treatment with the goal of preventing recurrent CDI may offer a better guide than disease severity.

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The StoP CDI Study

The StoP CDI study will test this idea in a randomized, double-blinded, placebo-controlled trial.

If successful in demonstrating that vancomycin can prevent the disease, the research could save thousands of lives, stop tens of thousands of infections, and save millions of health care dollars.

The Agency for Healthcare Research and Quality recently awarded Dr. Sims with a $2.4 million grant to study a theory that could prevent thousands of C. difficile infections and deaths all over the world. This is one of the largest grants Beaumont Health has ever received.

Ms Post was diagnosed with a Clostridium difficile infection and was treated for it with vancomycin and got better. However, a few days after she stopped the vancomycin, the diarrhea would come back as the infection relapsed. After talking with several doctors she was directed to Matthew Sims, M.D., PhD, director of infectious disease research at Beaumont Hospital, Royal Oak, who enrolled her in a research study and broke the cycle of relapses.

Dr. Sims believes oral vancomycin can keep the C. diff in check when the good bacteria is killed by other antibiotics and should prevent the patient from becoming sick. Participants in the study will be given vancomycin or a placebo along with the antibiotics treating the original infection.


Beaumont Hospital, Royal Oak

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