From the Guidelines
Ribotype 027, also known as NAP1/BI/027, is a highly virulent strain of Clostridioides difficile (C. difficile) that requires aggressive management due to its severity, with first-line treatment including oral vancomycin (125 mg four times daily for 10-14 days) or fidaxomicin (200 mg twice daily for 10 days), as recommended by the most recent guidelines 1.
Key Characteristics of Ribotype 027
- Produces significantly more toxins A and B than other strains
- Has enhanced spore formation
- Carries resistance to fluoroquinolone antibiotics
Treatment Approach
- First-line treatment: oral vancomycin (125 mg four times daily for 10-14 days) or fidaxomicin (200 mg twice daily for 10 days) 1
- Severe or complicated cases: higher doses of vancomycin (500 mg four times daily), possibly combined with intravenous metronidazole (500 mg every 8 hours) 1
- Recurrent infections: extended vancomycin tapers or fecal microbiota transplantation may be necessary 1
Prevention Measures
- Strict infection control practices
- Antimicrobial stewardship to limit fluoroquinolone use
- Enhanced environmental cleaning with sporicidal agents 1 The increased virulence of Ribotype 027 is attributed to its hyperproduction of toxins and resistance to commonly used antibiotics, making it particularly challenging to manage in healthcare settings 1.
From the Research
Significance of Ribotype 027
The Ribotype 027 strain of Clostridioides difficile is a major contributor to the increase in mortality, severity of CDI outbreaks, and recurrence rates of CDI 2. This strain has been associated with a higher risk of severe and complicated disease, as well as a higher risk of recurrence 3, 4.
Characteristics of Ribotype 027
The Ribotype 027 strain is characterized by its high virulence and ability to produce toxins that can cause severe diarrhea and colitis 5. This strain is also highly resistant to antibiotics, making treatment challenging 6.
Impact on Treatment
The presence of Ribotype 027 can impact treatment outcomes, with higher recurrence rates and lower response rates to standard therapies 2, 3. Alternative treatments, such as fecal microbiota transplantation and bezlotoxumab, may be considered for patients with recurrent CDI caused by this strain 4, 6.
Key Considerations
- Ribotype 027 is a highly virulent strain of C. difficile that can cause severe and complicated disease 5
- Treatment outcomes may be impacted by the presence of this strain, with higher recurrence rates and lower response rates to standard therapies 2, 3
- Alternative treatments, such as fecal microbiota transplantation and bezlotoxumab, may be considered for patients with recurrent CDI caused by this strain 4, 6