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A Protocol to Characterize the Morphological Changes of Clostridium difficile in Response to Antibiotic Treatment
Published on: May 25, 2017
An Analysis of Clostridium difficile Environmental Contamination During and After Treatment for C difficile Infection
Kerrie Davies1, Damian Mawer2, A Sarah Walker3,4
1Healthcare Associated Infection Research Group, Leeds Teaching Hospitals NHS Trust and University of Leeds, Leeds, United Kingdom.
Background:
Lower Clostridium difficile spore counts in feces from C difficile infection (CDI) patients treated with fidaxomicin versus vancomycin have been observed. We aimed to determine whether environmental contamination is lower in patients treated with fidaxomicin compared with those treated with vancomycin/metronidazole.
Methods:
The CDI cases were recruited at 4 UK hospitals (Leeds, Bradford, and London [2 centers]). Environmental samples (5 room sites) were taken pretreatment and at 2-3, 4-5, 6-8, and 9-12 days of treatment, end of treatment (EOT), and post-EOT. Fecal samples were collected at diagnosis and as often as produced thereafter. Swabs/feces were cultured for C difficile; percentage of C difficile-positive samples and C difficile bioburden were compared between different treatment arms at each time point.
Results:
Pre-EOT (n = 244), there was a significant reduction in environmental contamination (≥1 site positive) around fidaxomicin versus vancomycin/metronidazole recipients at days 4-5 (30% vs 50% recipients, P = .04) and at days 9-12 (22% vs 49%, P = .005). This trend was consistently seen at all other timepoints, but it was not statistically significant. No differences were seen between treatment groups post-EOT (n = 76). Fidaxomicin-associated fecal positivity rates and colony counts were consistently lower than those for vancomycin/metronidazole from days 4 to 5 of treatment (including post-EOT); however, the only significant difference was in positivity rate at days 9-12 (15% vs 55%, P = .03).
Conclusions:
There were significant reductions in C difficile recovery from both feces and the environment around fidaxomicin versus vancomycin/metronidazole recipients. Therefore, fidaxomicin treatment may lower the C difficile transmission risk by reducing excretion and environmental contamination.
Insights
Fidaxomicin treatment for Clostridium difficile infection (CDI) significantly reduced environmental contamination and fecal shedding compared to vancomycin/metronidazole. This suggests fidaxomicin may lower CDI transmission risk.
Area of Science:
- Infectious Diseases
- Microbiology
- Clinical Pharmacology
Background:
- Clostridium difficile infection (CDI) poses a significant public health challenge.
- Fidaxomicin has shown promise in reducing spore counts compared to vancomycin.
- Understanding environmental contamination is crucial for CDI control.
Purpose of the Study:
- To compare environmental contamination levels in patients with CDI treated with fidaxomicin versus vancomycin/metronidazole.
- To assess the impact of treatment on fecal shedding of C. difficile.
Main Methods:
- Environmental and fecal samples were collected from CDI patients across four UK hospitals.
- Samples were analyzed for C. difficile presence and bioburden at various treatment time points.
- Statistical comparisons were made between fidaxomicin and vancomycin/metronidazole treatment arms.
Main Results:
- Fidaxomicin treatment led to significantly lower environmental contamination at days 4-5 and 9-12 post-treatment initiation.
- Fecal positivity rates and C. difficile bioburden were consistently lower with fidaxomicin.
- No significant differences in contamination were observed post-end of treatment.
Conclusions:
- Fidaxomicin treatment significantly reduces C. difficile recovery from both feces and the environment.
- Fidaxomicin may decrease the risk of CDI transmission by lowering patient shedding and environmental contamination.
- This finding supports fidaxomicin as a potentially valuable agent in CDI management and infection control.
