ACCORDING to recent research, vancomycin, a first-line antibiotic used in the treatment of Clostridioides difficile infection (CDI), may be decreasing in effectiveness as rates of antimicrobial resistance continue to grow. As a leading cause of morbidity and mortality in several countries, the continuous increase in antibiotic-resistant strains of C. difficile represents a significant health concern. Indeed, the clinical cure rates of oral treatment with vancomycin have declined by approximately 30% since the early 2000s.
Researchers from the University of Houston and Texas A&M Health Science Centre, USA, conducted a multicentre, 14-hospital cohort study comprising 300 adult patients (56% non-Hispanic White background, and female) with CDI admitted to one of two university-affiliated hospitals between 2016–2021. Each of the patients had been treated orally with vancomycin monotherapy within 48 hours of testing positive for CDI. In total, 48% of patients had either severe (43.3%) or fulminant (5%) CDI, according to the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) criteria.
Of the cohort, 83% met the primary end-point of 30-day sustained clinical response. Of the remaining 17%, 20 had continued diarrhoea on Day 14, nine had recurrent disease within 30 days, and 22 passed away within 30 days of testing positive for CDI. Overall, 76% of patients with CDI, exhibiting reduced susceptibility to vancomycin, indicated decreased rates of 30-day sustained clinical response, compared to 86% of those with vancomycin-susceptible CDI (p=0.031). Likewise, the number of patients who experienced a 14-day initial cure was significantly reduced among the reduced-susceptibility CDI cohort (p=0.04).
In regards to these findings, co-author Kevin Garey, University of Houston College of Pharmacy, commented: “It’s an alarming development in the field of C. difficile, as there are only two recommended antibiotics. If antimicrobial resistance increases in both antibiotics, it will complicate the management of C. difficile infection, leading us back to a pre-antibiotic era.”
Reference
Eubank TA et al. Reduced vancomycin susceptibility in Clostridioides difficile is associated with lower rates of initial cure and sustained clinical response. Clin Infect Dis. 2024; DOI: 10.1093/cid/ciae087.
