An Analysis of Clostridium difficile Environmental Contamination During and After Treatment for C difficile Infection

Abstract

Background Lower C. difficile spore counts in faeces from C. difficile infection (CDI) patients treated with fidaxomicin vs vancomycin have been observed. We aimed to determine if environmental contamination is lower in patients treated with fidaxomicin compared with those treated with vancomycin/metronidazole. Methods CDI cases were recruited at four UK hospitals (Leeds, Bradford, Londonx2). Environmental samples (five room sites) were taken pre-treatment, and at 2-3, 4-5, 6-8 and 9-12 days of treatment, end of treatment (EOT), and post-EOT. Faecal samples were collected at diagnosis and as often as produced thereafter. Swabs/ faeces were cultured for C. difficile; percentage of C. difficile positive samples and C. difficile bioburden were compared between different treatment arms at each time-point. Results Pre-EOT (n=244) there was a significant reduction in environmental contamination (≥ one site positive) around fidaxomicin vs vancomycin/metronidazole recipients at days 4-5 (30% vs 50% recipients, p=0.04), and at days 9-12 (22% vs 49%, p=0.005). This trend was consistently seen at all other timepoints, but was not statistically significant. No differences were seen between treatment groups post-EOT (n=76). Fidaxomicin-associated faecal positivity rates and colony counts were consistently lower than those for vancomycin/metronidazole from days 4-5 of treatment (including post-EOT); however, the only significant difference was in positivity rate at days 9-12 (15% vs 55%, p=0.03). Conclusions There were significant reductions in C. difficile recovery from both faeces and the environment around fidaxomicin vs vancomycin/metronidazole recipients. Fidaxomicin treatment may therefore lower the C. difficile transmission risk by reducing excretion and environmental contamination.

The Impact of Infection Versus Colonization on Clostridioides difficile Environmental Contamination in Hospitalized Patients With Diarrhea

“…Several previously published studies identified C difficile in approximately 15% of samples overall and 17%–27% of samples from the patient bathroom [ 12 , 16 , 17 ]. In contrast, Davies et al [ 18 ] and Gilboa et al [ 19 ] identified C difficile in 30%–70% of samples from C difficile patient rooms, and Curry et al [ 20 ] identified C difficile in 5 of 6 colonized patient rooms but not primarily in the bathroom [ 18 , 19 ]. Although differences in recovery rate could be related to patient mix and timing of sampling, we suspect that the sampling technique contributed to these differences.…”

“…Although differences in recovery rate could be related to patient mix and timing of sampling, we suspect that the sampling technique contributed to these differences. Davies et al [ 18 ], Gilboa et al [ 19 ], and our study used the sponge and stomacher technique, which allows for sampling of a much larger surface area than contact plates or cotton swabs. In addition, Curry et al did not include the bathroom floor as a sample location as our study did, which likely contributed to our difference in findings in the bathroom.…”

Fidaxomicin for the Treatment of Clostridioides difficile Infection in Adult Patients: An Update on Results from Randomized Controlled Trials

“…Another effect of fidaxomicin reported in in vitro studies, not observed with vancomycin, is the inhibition of biofilm formation, which could have implications for reducing the risk of both C. difficile colonization and CDI [ 64 , 65 , 66 , 67 ]. Finally, reduced shedding and environmental contamination by C. difficile have been described with fidaxomicin treatment more than with metronidazole or, although to a lesser extent, vancomycin [ 68 , 69 , 70 , 71 ].…”

Opportunities for Nanomedicine in Clostridioides difficile Infection

“…Fidaxomicin was approved by the FDA in 2011 as a new CDI treatment option, as it showed superior efficacy with significantly less impact on normal colonic flora than vancomycin [ 70 ]. Fidaxomicin treatment also inhibits sporulation and decreases spore shedding into the environment [ 71 , 72 ]. Despite only one resistant isolate being reported to date [ 73 ], development of non-antibiotic therapy to prevent therapeutic resistance is urgently needed for CDI control.…”