Randomized Controlled Trial of Oral Vancomycin Treatment in Clostridioides difficile-Colonized Patients

Details

• Personal Author:
  Burnham C-AD ; Cass C ; Dantas G ; Dubberke ER ; Fishbein SRS ; Hink T ; Iqbal ZH ; Kwon JH ; Reske KA ; Seiler S ; Struttmann E
• Description:
  Clostridioides difficile infection (CDI) is most commonly diagnosed using nucleic acid amplification tests (NAAT); the low positive predictive value of these assays results in patients colonized with C. difficile unnecessarily receiving CDI treatment antibiotics. The risks and benefits of antibiotic treatment in individuals with such cases are unknown. Fecal samples of NAAT-positive, toxin enzyme immunoassay (EIA)-negative patients were collected before, during, and after randomization to vancomycin (n = 8) or placebo (n = 7). C. difficile and antibiotic-resistant organisms (AROs) were selectively cultured from fecal and environmental samples. Shotgun metagenomics and comparative isolate genomics were used to understand the impact of oral vancomycin on the microbiome and environmental contamination. Overall, 80% of placebo patients and 71% of vancomycin patients were colonized with C. difficile posttreatment. One person randomized to placebo subsequently received treatment for CDI. In the vancomycin-treated group, beta-diversity (P =0.0059) and macrolide-lincosamide-streptogramin (MLS) resistance genes (P = 0.037) increased after treatment; C. difficile and vancomycin-resistant enterococci (VRE) environmental contamination was found in 53% of patients and 26% of patients, respectively. We found that vancomycin alters the gut microbiota, does not permanently clear C. difficile, and is associated with VRE colonization/environmental contamination. [Description provided by NIOSH]
• Subjects:
  Anti-Bacterial Agents Environmental Pollution Occupational Health Safety
• Keywords:
  Antibacterial Agents Antibiotics Author Keywords: C. Difficile Bacteria Bacterial Infections Environmental Contamination Genomics Medical Treatment Vancomycin Vancomycin-resistant Enterococci
• ISSN:
  2379-5042
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Missouri ; OSHA Region 7
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  6
• Issue:
  1
• NIOSHTIC Number:
  nn:20062156
• Citation:
  mSphere 2021 Jan/Feb; 6(1):e00936-20
• Contact Point Address:
  Gautam Dantas, The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, Missouri, USA
• Email:
  dantas@wustl.edu
• CAS Registry Number:
  Vancomycin (CAS RN 1404-90-6)
• Federal Fiscal Year:
  2021
• NORA Priority Area:
  Agriculture, Forestry and Fishing
• Performing Organization:
  Washington University, Saint Louis
• Peer Reviewed:
  True
• Start Date:
  20180901
• Source Full Name:
  mSphere
• End Date:
  20220831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:1927234881b482509c49df79a67c0b57cb3ffeb45c05a65d263f00141da0db062fda380f34990dfc687433cf19515419cab37daf23200848f84bd482ffd84587
• Download URL:
  https://stacks.cdc.gov/view/cdc/225458/cdc_225458_DS1.pdf
• File Type:
  [PDF - 1.11 MB ]