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BI strain of C. difficile associated with lower cure rate, high recurrence rate
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Among patients with the BI Clostridium difficile strain, the clinical cure rate is lower and the recurrence rate is increased when compared with patients with other strains of C. difficile, researchers from Edward Hines Jr. VA Hospital suggest.
According to the researchers, this strain of C. difficile has been found in more than half of the stool samples collected for several North American surveys. It reached epidemic status in 2000 and has recently demonstrated resistance against the typical C. difficile treatments: vancomycin and metronidazole.
C. difficile isolates were collected from two phase 3 trials in which vancomycin and fidaxomicin (Dificid, Optimer Pharmaceuticals) were being compared. They analyzed the cure rate and recurrence rate by strain, BI and non-BI.
There were 719 isolates available. The BI strain was the most common, comprising 34% of the isolates. Patients who had the BI strain had a clinical cure rate of 86.6% vs. a cure rate of 94.3% for those who had non-BI strains. The cure rate difference was significant for vancomycin and fidaxomicin.
The recurrence rate for patients with the BI strain was 27.4% compared with a recurrence rate of 16.6% for patients with non-BI strains. On multivariate analysis, infection with the BI strain was significantly associated with reduced cure rate and increased recurrence rate.
“Laboratories can now rapidly identify patients with the BI strain of C. difficile using a specific [polymerase chain reaction] test,” the researchers wrote. “However, it is not clear what the preferred treatment of such patients should be. More effective treatments of the epidemic BI strain are needed.”
References:
Petrella LA. Clin Infect Dis. 2012;55:351-357.
Disclosures:
The researchers report financial relationships with Actelion, Astellas, Bio-K+, BioRelix, Cangene, Cubist, Eurofins Medinet, GOJO, Medicines Co., Merck, Optimer, Pfizer, Sanofi-Pasteur, TheraDoc and Viropharma.