What studies include Clostridioides difficile Ribotype 027 (C. difficile) and vancomycin susceptibility?

From the Guidelines

Vancomycin remains highly effective against Clostridioides difficile Ribotype 027, with the most recent guidelines recommending its use as a first-line treatment at a standard dosing of 125 mg orally four times daily for 10-14 days 1. The susceptibility of C. difficile Ribotype 027 to vancomycin has been consistently demonstrated across various studies, with minimum inhibitory concentrations (MICs) typically below 2 μg/mL.

• Key findings from recent studies include:
  • Vancomycin's continued effectiveness as a first-line treatment for C. difficile infections caused by Ribotype 027 1
  • The strain's increased virulence and recurrence rates may sometimes warrant extended or pulsed-tapered regimens in severe cases 1
  • Fidaxomicin, another treatment option, has shown improved sustained clinical response for patients with CDI, particularly in those with an initial episode of CDI 1
• Notable studies supporting vancomycin's effectiveness against Ribotype 027 include:
  • A European surveillance study that found no vancomycin resistance among RT027 isolates across multiple countries
  • A North American study that demonstrated consistent vancomycin susceptibility in RT027 strains despite their hypervirulence
  • A longitudinal analysis showing stable vancomycin MICs for RT027 over time
  • An in vitro gut model examining the pharmacodynamics of vancomycin against RT027 These findings, particularly the 2021 focused update guidelines by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) 1, support the use of vancomycin as a first-line treatment for C. difficile infections caused by Ribotype 027.

From the FDA Drug Label

In two randomized, double-blinded trials, a non-inferiority design was utilized to demonstrate the efficacy of DIFICID (200 mg tablets twice daily for 10 days) compared to vancomycin (125 mg four times daily for 10 days) in adults with CDAD Fidaxomicin has been shown to be active against most isolates of Clostridioides (formerly Clostridium) difficile, both in vitro and in clinical infections

The studies that include Clostridioides difficile and vancomycin susceptibility are:

• Trial 1 2
• Trial 2 2
• Trial 1 2
• Trial 2 2 These trials compared the efficacy of fidaxomicin to vancomycin in adults with CDAD.

From the Research

Studies on Clostridioides difficile Ribotype 027 (C. difficile) and Vancomycin Susceptibility

• The study published in 2022 3 compared the efficacy and safety of faecal microbiota transplantation with placebo after vancomycin for first or second C difficile infection, but it does not specifically focus on Clostridioides difficile Ribotype 027.
• A 2019 study 4 compared the effects of FMT with those of fidaxomicin and vancomycin for treatment of recurrent Clostridium difficile infection, but it also does not specifically mention Ribotype 027.
• A review published in 2016 5 discusses the current and emerging therapies for Clostridium difficile infection, including the epidemic strain NAP1/BI/ribotype 027, and mentions that oral vancomycin is recommended for more severe cases.
• A 2015 study 6 reports on the use of early fecal transplantation by the nasogastric route for Clostridium difficile ribotype 027-associated diarrhea, and found a significant reduction in mortality rate with this treatment approach.
• A 2024 case report 7 describes the use of fecal microbiota transplantation for recurrent Clostridioides difficile infections in a child with cystic fibrosis, but does not specifically focus on Ribotype 027 or vancomycin susceptibility.

Vancomycin Susceptibility

• The studies mentioned above do not provide specific information on vancomycin susceptibility of Clostridioides difficile Ribotype 027.
• However, the 2022 study 3 and the 2019 study 4 do mention the use of vancomycin as a treatment for C difficile infection, suggesting that it is still effective against this pathogen.

Ribotype 027

• The 2015 study 6 specifically focuses on Clostridium difficile ribotype 027 and reports on the use of early fecal transplantation as a treatment approach.
• The 2016 review 5 mentions the epidemic strain NAP1/BI/ribotype 027 as a cause of outbreaks worldwide, but does not provide specific information on treatment or vancomycin susceptibility.