Antibiotic choice impacts C. difficile shedding and hospital contamination, study finds
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Fidaxomicin and vancomycin reduced shedding of Clostridioides difficile spores faster and were associated with lower rates of hospital contamination compared with metronidazole, according to study findings.
“One unique facet of infectious diseases is the infectious part. How we treat our patients matters not just to their own health but to those around them as well,” Nicholas Turner, MD, MHSc, assistant professor of medicine in the division of infectious diseases at Duke University Medical Center, told Healio.
“Having seen different clinical response rates to C. difficile treatments, we began to wonder whether treatment choice might influence not only rapidity of recovery but also risk of transmission within the hospital,” Turner said.
Turner and colleagues performed a prospective, unblinded, randomized controlled trial of hospitalized adults with C. difficile infection during which individuals were randomly assigned in a 1:1:1 ratio to receive fidaxomicin, oral vancomycin or metronidazole.
Of the 33 patients enrolled in the study, 31 completed it. Among these patients, researchers found that fidaxomicin and vancomycin were associated with more rapid decline in C. difficile shedding when compared with metronidazole. Additionally, both vancomycin (6.3%; 95% CI, 4.7%-8.3%) and fidaxomicin (13.1%; 95% CI, 10.7%-15.9%) were associated with lower rates of environmental contamination than metronidazole (21.4%; 95% CI, 18%-25.2%).
When the researchers performed specific modeling assessing subject change over time, fidaxomicin (adjusted OR = 0.83; 95% CI, 0.7-0.99) was associated with more rapid decline in environmental contamination than vancomycin or metronidazole.
“Treatment choices for C. difficile might have implications not just for your patient but for the next person to occupy the room,” Turner said. “By reducing shedding and room contamination, vancomycin or fidaxomicin may have a role in reducing health care-associated C. difficile rates.”
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