scholarly journals Clearance of Vancomycin-Resistant Enterococcus Concomitant With Administration of a Microbiota-Based Drug Targeted at Recurrent Clostridium difficile Infection

2016 ◽  
Vol 3 (3) ◽  
Author(s):  
Erik R. Dubberke ◽  
Kathleen M. Mullane ◽  
Dale N. Gerding ◽  
Christine H. Lee ◽  
Thomas J. Louie ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Small Sample Size ◽  
Secondary Analysis ◽  
Small Sample ◽  
Vancomycin Resistant Enterococcus ◽  
Recurrent Clostridium Difficile Infection ◽  
Stool Samples ◽  
Vancomycin Resistant

Abstract Background.  Vancomycin-resistant Enterococcus (VRE) is a major healthcare-associated pathogen and a well known complication among transplant and immunocompromised patients. We report on stool VRE clearance in a post hoc analysis of the Phase 2 PUNCH CD study assessing a microbiota-based drug for recurrent Clostridium difficile infection (CDI). Methods.  A total of 34 patients enrolled in the PUNCH CD study received 1 or 2 doses of RBX2660 (microbiota suspension). Patients were requested to voluntarily submit stool samples at baseline and at 7, 30, and 60 days and 6 months after the last administration of RBX2660. Stool samples were tested for VRE using bile esculin azide agar with 6 µg/mL vancomycin and Gram staining. Vancomycin resistance was confirmed by Etest. Results.  VRE status (at least 1 test result) was available for 30 patients. All stool samples for 19 patients (63.3%, mean age 61.7 years, 68% female) tested VRE negative. Eleven patients (36.7%, mean age 75.5 years, 64% female) were VRE positive at the first test (baseline or 7-day follow-up). Of these patients, 72.7%, n = 8 converted to negative as of the last available follow-up (30 or 60 days or 6 months). Of the other 3: 1 died (follow-up data not available); 1 patient remained positive at all follow-ups; 1 patient retested positive at 6 months with negative tests during the interim. Conclusions.  Although based on a small sample size, this secondary analysis demonstrated the possibility of successfully converting a high percentage of VRE-positive patients to negative in a recurrent CDI population with RBX2660.

scholarly journals 670. VRE Clearance in Patients with Recurrent Clostridium difficile Infection Following Treatment with Microbiota-Based Drug RBX2660

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S306-S307
Author(s):  
Heidi Hau ◽  
Sarah Mische ◽  
Sarah Klein ◽  
Ken Blount
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Cohort Analysis ◽  
Intestinal Microbiome ◽  
Phase 2 ◽  
Open Label ◽  
Recurrent Clostridium Difficile Infection ◽  
Gram Staining ◽  
Increased Risk ◽  
Stool Samples

Abstract Background Vancomycin-resistant Enterococcus (VRE) infection is frequently associated with immunocompromised and critically ill patients. VRE carriers are at increased risk for infection due to VRE colonization and they pose a risk as a transmission source. VRE infection and Clostridium difficile infection (CDI) share common risk factors, including disruption of the intestinal microbiome. Thus, therapeutic approaches that decolonize VRE would be valuable. Herein, we report on stool VRE clearance in a cohort analysis from a Phase 2 open-label study of RBX2660, standardized microbiota-based drug, for recurrent CDI. Methods This prospective, multicenter, open-label Phase 2 study enrolled subjects with recurrent CDI. Participants received up to 2 doses of RBX2660 delivered via enema with doses 7 days apart. Patients were requested to voluntarily submit stool samples at baseline and at 7, 30 and 60 days, 6, 12, and 24 months after the last administration of RBX2660. Stool samples were tested for VRE using bile esculin azide agar with 6 µg/mL vancomycin and gram staining. Vancomycin resistance was confirmed via blood agar and etest. Results Stool samples were available for 143 patients. Twenty-one patients were VRE-positive at the first test (baseline or 7 day). Of the 19 VRE-positive patients that provided additional samples at later timepoints, 18 (94.7%) converted to negative as of the last available follow-up (30 or 60 days and 6, 12, or 24 months). The remaining patient remained positive at all follow-ups. Conclusion This cohort analysis of VRE-positive patients within an rCDI population provides additional support that microbiota-based formulations, such as RBX2660, may have additional benefit beyond reducing the recurrence of CDI. Additional study is needed to confirm the role of microbiome restoration on VRE clearance. Disclosures All authors: No reported disclosures

Undetected Vancomycin-Resistant Enterococcus Stool Colonization in a Veterans Affairs Hospital Using a Clostridium difficile–Focused Surveillance Strategy

2002 ◽  
Vol 23 (8) ◽  
pp. 474-477 ◽  
Author(s):  
Amy J. Ray ◽  
Claudia K. Hoyen ◽  
Sarbani M. Das ◽  
Elizabeth C. Eckstein ◽  
Curtis J. Donskey
Keyword(s):  
Clostridium Difficile ◽  
Veterans Affairs ◽  
Point Prevalence ◽  
Vancomycin Resistant Enterococcus ◽  
Surveillance Strategy ◽  
Stool Samples ◽  
Vancomycin Resistant

Abstract We examined the point prevalence of undetected vancomycin-resistant Enterococcus (VRE) stool colonization in an institution that screens stool samples submitted for Clostridium difficile testing. Of 112 patients not known to be colonized, 10 (9%) had rectal VRE colonization. A prospective algorithm was effective for identification of colonized patients.

scholarly journals Does Adjunctive Tigecycline Improve Outcomes in Severe-Complicated, Nonoperative Clostridium difficile Infection?

2017 ◽  
Vol 4 (1) ◽  
Author(s):  
Mary T. LaSalvia ◽  
Westyn Branch-Elliman ◽  
Graham M. Snyder ◽  
Monica V. Mahoney ◽  
Carolyn D. Alonso ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Surgical Intervention ◽  
Small Sample Size ◽  
Severity Of Illness ◽  
Small Sample ◽  
High Rate ◽  
Limited Power ◽  
Severe Clostridium Difficile Infection ◽  
To Receive

Abstract Severe Clostridium difficile infection is associated with a high rate of mortality; however, the optimal treatment for severe- complicated infection remains uncertain for patients who are not candidates for surgical intervention. Thus, we sought to evaluate the benefit of adjunctive tigecycline in this patient population using a retrospective cohort adjusted for propensity to receive tigecycline. We found that patients who received tigecycline had similar outcomes to those who did not, although the small sample size limited power to adjust for comorbidities and severity of illness.

scholarly journals Risk factors for recurrent Clostridium difficile infection among patients in the Clinical Centre of Vojvodina, Serbia: A retrospective clinical trial

2019 ◽  
Vol 76 (4) ◽  
pp. 392-397
Author(s):  
Nadica Kovacevic ◽  
Radoslava Doder ◽  
Tomislav Preveden ◽  
Maria Pete
Keyword(s):  
Risk Factors ◽  
Clinical Trial ◽  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Recurrent Clostridium Difficile Infection ◽  
Clinical Center ◽  
End Of Treatment ◽  
Clinical Centre ◽  
Oral Metronidazole

Background/Aim. In the last two decades the incidence of recurrent Clostridium difficile infection (CDI) has risen. The aim of this study was to determine the risk factors for the recurrent CDI among patients hospitalized with the initial CDI. Methods. We conducted a retrospective clinical trial at the Clinic for Infectious Diseases, Clinical Center of Vojvodina, Serbia, between January 2010 and January 2016. We enrolled 488 patients with the initial CDI who were treated with oral vancomycin (125 mg, 4 times per day) or oral metronidazole (400 mg, 3 times per day) for 10 days. After the completion of therapy, there was 60 days of the follow-up period for the assessment of the rates of relapse. To determine the risk factors for the CDI relapse, we compared the demographics, clinical and laboratory characteristics of the patients who had a relapse with the patients who had a stable clinical response. Results. Of the 488 cases, 29.09% recurred. The relapse occured in 22.72% patients who received vancomycin and in 36.60% patients treated with metronidazole (p = 0.038). A statistically significant effect on the CDI relapse had the comorbidities such as a malignancies (19.52% vs 8.82%, p = 0.023) and the postoperative CDI (25.67% vs 10.29%, p = 0.035), hipoalbuminemia (< 25 g/L) (70.27% vs 41.94%; p = 0.034) and the concomitant antibiotic therapy (50.67% vs 20.29%; p = 0.031). The persistence of C. difficile toxin in the stool at the end of treatment was registered in 22.32% of patients treated with metronidazole vs 9.09% of patients given vancomycin (p = 0.03). Conclusion. Our data suggest that the important risk factors for the CDI relapse are comorbidities (surgery within a month before developing CDI and malignancy), hipoalbuminemia (< 25g/L) and concomitant non-CDI antibiotics therapy. Vancomycin is more effective than metronidazole in the elimination of C. difficile toxins. The presence of C. difficile toxins in the stool after the successful completion of the initial CDI therapy does not affect significantly the occurrence of relapse.

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