Six recent advances in C. difficile infection research

Clostridium difficile infection has increased rapidly throughout the past 10 years, occurring in more than ten cases per 1,000 hospitalized patients and recurring in up to 20% of treated patients by some estimates. The work of many researchers has helped to improve our understanding of this infection’s epidemiology and to develop new, more effective treatments.

Here are six highlights of research on C.difficile infection (CDI) recently presented by Healio.com/Gastroenterology and Infectious Disease News.

1. Fecal microbiota transplant (FMT) treated CDI in immunocompromised patients

Elizabeth L. Hohmann, MD, associate professor of medicine/infectious diseases at Massachusetts General Hospital/Harvard Medical School, and colleagues confirmed the safety and efficacy of FMT for treatment of CDI in immunocompromised patients.

Elizabeth L. Hohmann

“There has been worry about transmission of infection from FMT in these patients, and that was not demonstrated here,” Hohmann told Healio.com/Gastroenterology. “This is not a ‘freebie’ — there were [adverse events] and hospitalizations because these are sick patients, but cure rates were good and not too far off from what is seen in less sick patients.” Read more

2. Severity and outcomes of CDI in a US urban population improved

Paul Feuerstadt MD, FACG, Medical Research Center of Connecticut, Gastroenterology Center of Connecticut, and colleagues observed less CDI severity, better outcomes and lower mortality in the Bronx, N.Y. population in 2009-2011 compared with 2006-2008.

Paul Feuerstadt

“Our study shows that the epidemiology of CDI in a United States urban environment is changing,” Feuerstadt told Healio.com/Gastroenterology. “Clinicians appear to be more appropriate with their workup and therapy for CDI resulting in better outcomes, and this pattern should continue as we face increasing incidence of this disease.” Read more

3. Functional changes and changes in microbial structure occurred concurrently after FMT

Specific changes in gut microbiota structure after FMT in patients with recurrent CDI were associated with functional changes in a recent study.

“By comparing community composition and structure … we observed differences in functional potential of the microbiome based on the type of community present within individual recipient-donor pairs,” the investigators wrote. “While current success rates are high for treatment of CDI, a clear understanding of how FMT works has the potential to aid the development of alternative biotherapeutics.” Read more

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4. Probiotic drink plus antibiotic withdrawal regimen resolved CDI

Daily consumption of a probiotic drink paired with a staggered and tapered antibiotic withdrawal regimen, may be as effective as FMT at resolving recurrent CDI, according to a report in Clinical Infectious Diseases.

Johan S. Bakken

“FMT has been very effective, even more effective than any other recommended or published treatment,” Johan S. Bakken, MD, PhD, of St. Luke’s Hospital in Duluth, Minn., told Infectious Disease News. “However, some patients are adverse to FMT, or they are unable to find a donor or are unable to afford the cost of screening a potential donor or use a commercial stool bank. This is an alternative that may work just as well as fecal transplant.” Read more

5. Tolevamer inferior to current CDI treatments

Recent data indicate that tolevamer was inferior to both metronidazole and vancomycin for the treatment of patients with CDI.

“The non-antibiotic, toxin-binding agent tolevamer was not effective in treatment of CDI when compared to the antibiotic treatment arms,” the researchers wrote. “It is possible that this agent could be studied as an adjunctive treatment following standard antibiotic treatment for CDI, but these data do not support a luminal toxin binding approach with tolevamer as monotherapy for CDI.” Read more

6. CDI incidence has increased in Europe since 2008

The incidence of CDI in Europe has increased (compared with previous studies) from 4.12 to 7.92 cases per 10,000 patient bed days between 2008 and 2013, according to data presented at the 2014 European Congress of Clinical Microbiology and Infectious Diseases.

Mark H. Wilcox

“This study highlights that it is essential that we improve the implementation of CDI testing in hospitals in order to tackle the issue of the increasing incidence of CDI across Europe,” Mark H. Wilcox, MD, FRCPath, professor of medical microbiology at Leeds Teaching Hospitals and University of Leeds, said in a press release. Read more