Initial vancomycin for first episode non-severe Clostridium difficile infection

BackgroundClostridium difficile infection (CDI) is an important cause of nosocomial diarrhea. Given the discrepancy in current treatment guidelines for mild CDI, we sought to evaluate the use of first-line vancomycin for the treatment of non-severe infection.MethodsWe conducted a retrospective cohort study of all adult inpatients with first episode CDI at our institution from January 2013 to May 2018. CDI was defined as a positive C. difficile loop-mediated isothermal amplification assay, in conjunction with ≥3 type 5–7 stools on the Bristol stool scale. To evaluate the impact of first-line vancomycin treatment on adverse clinical outcomes in patients with first episode non-severe CDI, the initial vancomycin vs. initial metronidazole cohorts were first examined in an unadjusted logistic regression analysis for any combination of relapse, recurrence, and all-cause 30-day mortality, followed by an adjusted multivariable analysis.ResultsA total of 737 cases were included. Patients had a median age of 72.3 years (Q1: 61.2, Q3: 83.3) and 628 (85.2%) were classified as non-severe CDI. Among patients with non-severe CDI (n = 628), relapse, recurrence, and mortality rates were 17.4%, 7.0%, and 11.4%, respectively, when treated with initial metronidazole, compared to 18.6%, 3.1%, and 7.8%, respectively, when treated with initial vancomycin. In an adjusted multivariable analysis, the use of first-line vancomycin for the treatment of non-severe CDI was associated with a reduction in recurrence or 30-day mortality (ORadj: 0.51; 95%CI: 0.28–0.94; P=0.03).ConclusionsInitial vancomycin was associated with reduced recurrence or all-cause 30-day mortality in the treatment of adult inpatients with first episode non-severe CDI. Our findings support the use of initial vancomycin for all C. difficile inpatients, irrespective of disease severity, as recommended by Infectious Diseases Society of America guidelines.

Genetic Determinants of Trehalose Utilization Are Not Associated With Severe Clostridium difficile Infection Outcome

In a case–control study of patients with Clostridium difficile infection, we found no statistically significant association between the presence of trehalose utilization variants in infecting C. difficile strains and development of severe infection outcome. These results do not support trehalose utilization conferring enhanced virulence in the context of human C. difficile infections.

Genetic determinants of trehalose utilization are not associated with severe Clostridium difficile infection

ABSTRACTIn a case-control study of patients with C. difficile infection we found no statistically significant association between the presence of trehalose utilization variants in infecting C. difficile strains and development of severe infection. These results do not support trehalose utilization conferring enhanced virulence in the context of human C. difficile infections.