Abstract
Vancomycin is frequently used for the treatment of C. difficile infections (CDI). There are concerns that this might increase the risk of selecting vancomycin resistant enterococci (VRE). Here, we evaluated whether there is an increased risk of VRE acquisition following vancomycin for CDI specific treatment. Patients with CDI, metronidazole, or oral vancomycin treatment and without preexisting VRE were monitored for VRE acquisition. VRE isolates from patients with acquired and preexisting colonization were collected and subjected to whole genome sequencing. In total, 281 patients (median age 56 years, 54% of the male sex) presented with toxin positive C. difficile. Of them, 170 patients met the inclusion criteria, comprising 37 patients treated with metronidazole and 133 treated with oral vancomycin. In total, 14 patients meeting the inclusion criteria acquired VRE (vancomycin: n = 11; metronidazole: n = 3). Statistical analysis revealed no significant differences between both VRE acquisition rates. Genetic comparison of detected VRE isolates resulted in eight clusters of closely related genotypes comprising acquired and preexisting strains. Our results suggest that vancomycin and metronidazole likewise increase the risk of VRE acquisition. Genetic comparison indicates that VRE acquisition is a result of both antibiotic selection and pathogen transmission.
Highlights
In past decades, Clostridioides difficile infections (CDI) have evolved into one of the most common healthcare-associated infections worldwide
As hospital-acquired vancomycin resistant enterococci (VRE) are a result of interactions between host-associated factors, such as antibiotic selection and intra-hospital transmission [20,21] we assessed (i) whether oral vancomycin facilitates the acquisition of VRE compared to metronidazole treatment and (ii) if there are pathogen-specific genetic differences favoring VRE acquisition in CDI patients
Antibiotic treatment of CDI-affected patients can favor the acquisition of VRE
Summary
Clostridioides difficile infections (CDI) have evolved into one of the most common healthcare-associated infections worldwide. While formerly metronidazole has been considered the first-line agent treatment of non-severe CDI, since. 2021, fidaxomicin and alternately vancomycin are assessed as superior for these indications in the current clinical practice guidelines from the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America [3]. Metronidazole was preferred for mild or moderate infections previously but is considered for these indications in the latest guideline release of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) [4]. In the University Hospital Münster (UHM), non-severe CDI infections are treated with metronidazole, while patients with severe CDI infections receive oral vancomycin
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