Oral teicoplanin versus oral vancomycin for the treatment of severe Clostridium difficile infection: a prospective observational study

Popović, Nataša; Korać, Marija; Nesic, Zorica; Milošević, Branko; Urošević, Aleksandar; Jevtović, Djordje; Mitrović, Nenad; Marković, Aleksandar; Jordovic, Jelena; Katanic, Natasa; Barać, Aleksandra; Milošević, Ivana

doi:10.1007/s10096-017-3169-3

Cited by 23 publications

(13 citation statements)

References 36 publications

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“…Teicoplanin, though not approved for use in the US, is used as a treatment for CDI in Europe. A recent study found that teicoplanin may be the preferred choice for patients with severe CDI, because patients treated with teicoplanin had significantly lower recurrence rates than those treated with vancomycin (5, 50). As the use of teicoplanin as a treatment for CDI increases, care should be taken to consider the intrinsic sub-clinical teicoplanin resistance conferred by vanZ1 and the potential for selection of increased VanZ1 production as a mechanism of resistance.…”

Section: Discussionmentioning

confidence: 99%

Examination of the Clostridioides (Clostridium) difficile VanZ ortholog, CD1240

et al. 2018

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Clostridioides (Clostridium) difficile causes severe diarrheal disease that is directly associated with antibiotic use and resistance. Although C. difficile demonstrates intrinsic resistance to many antimicrobials, few genetic mechanisms of resistance have been characterized in this pathogen. In this study, we investigated the putative resistance factor, CD1240 (VanZ1), an ortholog of the teicoplanin resistance factor, VanZ, of Enterococcus faecium. In C. difficile, the vanZ1 gene is located within the skin element of the sporulation factor σ, which is excised from the mother cell compartment during sporulation. This unique localization enabled us to create a vanZ1 deletion mutant by inducing excision of the skin element. The Δskin mutant exhibited moderately decreased resistance to teicoplanin and had small effects on growth in some other cell-surface antimicrobials tested. Examination of vanZ1 expression revealed induction of vanZ1 transcription by the antimicrobial peptide LL-37; however, LL-37 resistance was not impacted by VanZ1, and none of the other tested antimicrobials induced vanZ1 expression. Further, expression of vanZ1 via an inducible promoter in the Δskin mutant restored growth in teicoplanin. These results demonstrate that like the E. faecium VanZ, C. difficile VanZ1 contributes to low-level teicoplanin resistance through an undefined mechanism.

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Section: Discussionmentioning

confidence: 99%

Examination of the Clostridioides (Clostridium) difficile VanZ ortholog, CD1240

et al. 2018

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“…Among 510 patients treated in this hospital from 2008-2013, the reported recurrence and case fatality rates were 8.4% and 6.3%, respectively (3). More severe forms of CDI and a notably higher recurrence rate were observed among patients treated in the same hospital from 2013-2015 (6). This suggested a potential outbreak of the ribotype 027 and emphasized the need for an analysis of the distribution of the C. difficile ribotypes among patients in Serbia.…”

Section: Introductionmentioning

confidence: 92%

“…The reports on C. difficile in Serbia are scarce (3)(4)(5)(6)(7)(8)(9)(10)(11). Since 2008, the University Hospital for Infectious and Tropical Diseases of the Clinical Center of Serbia in Belgrade has been the central Serbian institution for the treatment of patients with CDI (3).…”

Section: Introductionmentioning

confidence: 99%

Clostridioides difficile ribotype distribution in a large teaching hospital in Serbia

Korać

Rupnik

Nikolić

et al. 2020

Preprint

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Background: The global epidemic of nosocomial diarrhea caused by Clostridioides (Clostridium) difficile started in 2000, with high mortality rates and emergence of a new hypervirulent strain NAP1/BI/027. The aim of this study was to assess the presence of ribotype 027 and other C. difficile ribotypes in a Serbian University Hospital, compare the temporal variability of ribotypes three years apart, as well as to compare clinical, demographic and laboratory characteristics and disease outcome among patients infected with 027 and non-027 ribotype. This was a prospective observational cohort study addressing four-month intervals during 2014/2015 and 2017/2018. Results: Ribotyping was performed in 64 non-duplicate C. difficile strains. Ribotype 027 was the most prevalent, and was detected in 53 (82.8%) patients (43/45 and 10/19 patients in 2014-2015 and 2017/2018, respectively). Other detected ribotypes were 001/072 in 4 (6,3%), 002 in 4 (6,3%), 014/020 in 2 (3,1%) and 176 in 1 (1,5%) patient. The percentage of the patients infected with ribotype 027 significantly decreased during the three-year period, from 95.6% to 52.6% (p<0.001). Ribotype 027 infection was associated with fluoroquinolone treatment more frequently than infection with other ribotypes [33 (62.3%) vs. 2 (18.2%), p= 0.010)]. A severe C. difficile infection was diagnosed more often in patients with the detected ribotype 027 compared to those infected with non-027 ribotypes (p=0.006). No significant difference in the mortality and recurrence rates was found between the patients infected with ribotype 027 and those infected with other ribotypes [10/53 (18.8%) vs. 2/11 (18.2%), p=0.708, and 10/35 (28.6%) vs. 0/2 (0%), p=1.000, respectively].Conclusion: C. difficile ribotype 027 was the most prevalent ribotype among patients in a large Serbian hospital, but there is a clear decreasing trend.

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“…The number of recurrences was, however, lower (7% v 16%) but the difference was not statistically significant; however, the study was not powered to answer this question. A prospective observational study compared vancomycin with teicoplanin in patients with severe infection 115. Treatment with teicoplanin resulted in higher clinical cure rate (90.7% versus 79.4%) and fewer recurrences (9.3% v 34.3%), both percentages reaching statistical significance.…”

Section: Treatmentmentioning

confidence: 99%

Clostridioides difficile: diagnosis and treatments

Guery

Galpérine

Barbut

2019

BMJ

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Clostridioides difficile (formerly Clostridium) is a major cause of healthcare associated diarrhea, and is increasingly present in the community. Historically, C difficile infection was considered easy to diagnose and treat. Over the past two decades, however, diagnostic techniques have changed in line with a greater understanding of the physiopathology of C difficile infection and the use of new therapeutic molecules. The evolution of diagnosis showed there was an important under- and misdiagnosis of C difficile infection, emphasizing the importance of algorithms recommended by European and North American infectious diseases societies to obtain a reliable diagnosis. Previously, metronidazole was considered the reference drug to treat C difficile infection, but more recently vancomycin and other newer drugs are shown to have higher cure rates. Recurrence of infection represents a key parameter in the evaluation of new drugs, and the challenge is to target the right population with the adapted therapeutic molecule. In multiple recurrences, fecal microbiota transplantation is recommended. New approaches, including antibodies, vaccines, and new molecules are already available or in the pipeline, but more data are needed to support the inclusion of these in practice guidelines. This review aims to provide a baseline for clinicians to understand and stratify their choice in the diagnosis and treatment of C difficile infection based on the most recent data available.

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Oral teicoplanin versus oral vancomycin for the treatment of severe Clostridium difficile infection: a prospective observational study

Cited by 23 publications

References 36 publications

Examination of the Clostridioides (Clostridium) difficile VanZ ortholog, CD1240

Examination of the Clostridioides (Clostridium) difficile VanZ ortholog, CD1240

Clostridioides difficile ribotype distribution in a large teaching hospital in Serbia

Clostridioides difficile: diagnosis and treatments

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