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Updated: Oct 12, 2025
A Protocol to Characterize the Morphological Changes of Clostridium difficile in Response to Antibiotic Treatment
Published on: May 25, 2017
Impact of Clostridioides difficile Therapy on Nosocomial Acquisition of Vancomycin-Resistant Enterococci
Carlos L Correa-Martínez1, Niklas C J Hagemeier1, Neele J Froböse2
1Institute of Hygiene, University Hospital Münster, Robert-Koch-Straße 41, 48149 Münster, Germany.
Abstract:
Vancomycin is frequently used for the treatment of C. difficile infections (CDI). There are concerns that this might increase the risk of selecting vancomycin resistant enterococci (VRE). Here, we evaluated whether there is an increased risk of VRE acquisition following vancomycin for CDI specific treatment. Patients with CDI, metronidazole, or oral vancomycin treatment and without preexisting VRE were monitored for VRE acquisition. VRE isolates from patients with acquired and preexisting colonization were collected and subjected to whole genome sequencing. In total, 281 patients (median age 56 years, 54% of the male sex) presented with toxin positive C. difficile. Of them, 170 patients met the inclusion criteria, comprising 37 patients treated with metronidazole and 133 treated with oral vancomycin. In total, 14 patients meeting the inclusion criteria acquired VRE (vancomycin: n = 11; metronidazole: n = 3). Statistical analysis revealed no significant differences between both VRE acquisition rates. Genetic comparison of detected VRE isolates resulted in eight clusters of closely related genotypes comprising acquired and preexisting strains. Our results suggest that vancomycin and metronidazole likewise increase the risk of VRE acquisition. Genetic comparison indicates that VRE acquisition is a result of both antibiotic selection and pathogen transmission.
Insights
Vancomycin and metronidazole treatments for Clostridioides difficile infections (CDI) similarly increase the risk of acquiring vancomycin-resistant enterococci (VRE). VRE acquisition results from both antibiotic use and pathogen transmission.
Area of Science:
- Infectious Diseases
- Microbiology
- Pharmacology
Background:
- Vancomycin is a primary treatment for Clostridioides difficile infections (CDI).
- Concerns exist regarding vancomycin use potentially increasing the risk of vancomycin-resistant enterococci (VRE) acquisition.
- The comparative risk of VRE acquisition between vancomycin and metronidazole for CDI treatment requires investigation.
Purpose of the Study:
- To evaluate the risk of VRE acquisition in patients treated for CDI with oral vancomycin versus metronidazole.
- To compare VRE acquisition rates between the two treatment groups.
- To investigate the genetic relatedness of acquired and pre-existing VRE strains.
Main Methods:
- Prospective monitoring of patients with CDI treated with metronidazole or oral vancomycin for VRE acquisition.
- Collection and whole genome sequencing of VRE isolates from colonized or infected patients.
- Statistical analysis to compare VRE acquisition rates between treatment groups.
Main Results:
- A total of 170 patients met inclusion criteria (37 metronidazole, 133 vancomycin).
- 14 patients acquired VRE, with 11 in the vancomycin group and 3 in the metronidazole group.
- No significant difference in VRE acquisition rates was observed between vancomycin and metronidazole treatment groups.
- Whole genome sequencing revealed eight clusters of closely related VRE genotypes, indicating both antibiotic selection and transmission contribute to VRE acquisition.
Conclusions:
- Both vancomycin and metronidazole appear to increase the risk of VRE acquisition in CDI patients.
- VRE acquisition is influenced by a combination of antibiotic-induced selection pressure and pathogen transmission.
- Further research is warranted to understand and mitigate VRE risk during CDI treatment.
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