Related Experiment Video
Updated: Nov 21, 2025
07:06
Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection
Published on: December 8, 2014
27.4K
Randomized Controlled Trial of Oral Vancomycin Treatment in Clostridioides difficile-Colonized Patients
Skye R S Fishbein1,2, Tiffany Hink3, Kimberly A Reske3
1The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, Missouri, USA.
Msphere
|January 14, 2021
Summary
Oral vancomycin treatment for patients with positive NAAT and negative toxin tests for Clostridioides difficile infection (CDI) did not clear C. difficile. This treatment altered the gut microbiota and increased vancomycin-resistant enterococci (VRE) colonization and environmental contamination.
Area of Science:
- Microbiology
- Infectious Diseases
- Clinical Trials
Background:
- Clostridioides difficile infection (CDI) diagnosis often relies on nucleic acid amplification tests (NAAT), which have a low positive predictive value.
- Patients testing NAAT-positive but toxin enzyme immunoassay (EIA)-negative are frequently treated with oral vancomycin, despite uncertainty regarding risks and benefits.
- This population may not have active CDI but receives antibiotics, potentially leading to adverse effects and promoting antibiotic resistance.
Purpose of the Study:
- To evaluate the risk-benefit of oral vancomycin treatment in patients with NAAT-positive, EIA-negative results for CDI.
- To assess the impact of oral vancomycin on the gut microbiome, C. difficile colonization, and antibiotic-resistant organism (ARO) shedding and environmental contamination.
Main Methods:
- A double-blinded, randomized controlled trial involving 15 patients (8 vancomycin, 7 placebo) with NAAT-positive, EIA-negative stool tests.
- Collection of fecal and environmental samples before, during, and after treatment for selective culturing of C. difficile and AROs.
- Utilized shotgun metagenomics and comparative isolate genomics to analyze microbiome and resistance gene changes.
Main Results:
- Oral vancomycin did not lead to long-term clearance of C. difficile colonization (71% vs. 80% in placebo post-treatment).
- Vancomycin treatment significantly altered the gut microbiota's beta-diversity and increased macrolide-lincosamide-streptogramin (MLS) resistance genes.
- Increased colonization and environmental contamination with vancomycin-resistant enterococci (VRE) were observed in the vancomycin group (26% vs. unspecified in placebo).
Conclusions:
- Oral vancomycin treatment in this patient group does not achieve sustained C. difficile clearance.
- Vancomycin perturbs the gut microbiome and is associated with increased VRE colonization and environmental shedding.
- Further research is needed to understand the clinical outcomes and transmission dynamics of C. difficile and AROs in this population.
Related Concept Videos
01:29Drugs for Treatment of Ulcerative Colitis in IBD
311
Ulcerative colitis is a chronic inflammatory condition primarily affecting the colon and rectum. The primary drugs used in the treatment of ulcerative colitis are aminosalicylates. They exhibit anti-inflammatory and immunosuppressive properties. They modulate inflammatory mediators and inhibit the activity of nuclear factor κB (NF-κB). Aminosalicylates also reduce inflammation by inhibiting prostaglandin and leukotriene production and decreasing neutrophil chemotaxis and superoxide...
311
01:16Treating Helicobacter pylori in Peptic Ulcers: Antimicrobial Therapy
756
Helicobacter pylori, a resilient gram-negative bacterium, can thrive in the stomach's harsh, acidic environment. Infection with H. pylori leads to a cascade of events within the stomach lining. One of the critical disruptions caused by this bacterium is the interference with somatostatin production, a hormone responsible for regulating acid secretion. This interference tips the balance, escalating acid secretion and diminishing bicarbonate levels. This imbalance compromises the defensive...
756
01:17Drugs for Treatment of Diarrhea-Predominant IBS
433
Diarrhea-predominant irritable bowel syndrome (IBS-D) is a subtype of IBS characterized primarily by frequent, loose, or watery stools, abdominal pain, and abdominal discomfort. Therapeutic approaches to managing IBS-D include dietary changes, stress management techniques, and pharmaceutical interventions.
Two specific drugs used in the treatment are alosetron (Lotronex) and eluxadoline (Viberzi). Alosetron, a 5-HT3 antagonist, works by slowing the movement of stools in the gut, reducing bowel...
Two specific drugs used in the treatment are alosetron (Lotronex) and eluxadoline (Viberzi). Alosetron, a 5-HT3 antagonist, works by slowing the movement of stools in the gut, reducing bowel...
433
01:18Drugs Affecting GI Tract Motility: Antimicrobials as Antidiarrheal Agents
306
Acute diarrhea, a common gastrointestinal disturbance, is characterized by the rapid evacuation of fluid stools, leading to an excessive weight in fluid. This condition typically arises from disorders affecting intestinal water and electrolyte transport. It can be triggered by an increased osmotic load within the intestine, excessive secretion of electrolytes and water, mucosal exudation of protein and fluid, or altered intestinal motility. The primary risks of acute diarrhea are dehydration...
306
01:29Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
323
Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel...
323
01:21Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
296
Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2...
296