ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2025
Emergence and Spread of Clostridioides difficile Isolates With Reduced Fidaxomicin Susceptibility in an Acute Care Hospital.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Review
- Clinical failure of an extended-pulsed fidaxomicin regimen associated with emergence of aAntimicrobial agents and chemotherapy · 2026Article
- Argyrin B exhibits potent therapeutic efficacy in a Clostridioides difficile-infection mouse model while preserving microbiota functionality.npj antimicrobials and resistance · 2026Article
- A sensitive and reduced-cost culture medium for recovery ofJournal of clinical microbiology · 2026Article
- Carbadox, a veterinary growth promoter exhibits anticlostridial activity through induction of oxidative stress in Clostridioides difficile.Gut pathogens · 2026Article
- Observational
- Clostridioides difficile pathogenesis and control.Nature reviews. Microbiology · 2026Review
- Reversion of heme-dependent metronidazole resistance inMicrobiology spectrum · 2026Article
- Review
- Fidaxomicin Treatment of Clostridioides difficile Infections and Recurrences in Children and Adolescents: A Retrospective Multicenter Study.The Journal of pediatrics · 2025Observational
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Abstract
backgroundThere have been several recent reports of Clostridioides difficile infection (CDI) due to isolates with reduced fidaxomicin susceptibility (minimum inhibitory concentration [MIC] ≥ 2 µg/mL). However, the clinical implications are uncertain because fidaxomicin achieves high concentrations in the intestinal tract.
methodsIn an acute care hospital, we conducted a 3-year cohort study of patients with CDI to determine the frequency of infection with isolates with reduced fidaxomicin susceptibility and the impact on response to fidaxomicin treatment. Stool specimens were cultured for C. difficile, and susceptibility testing was performed using agar dilution. Whole-genome sequencing was used to identify mutations associated with reduced fidaxomicin susceptibility and to determine relatedness of isolates. For genomically related susceptible and reduced susceptibility isolates from the same patient, we compared rates of growth, sporulation, and toxin production.
resultsOf 108 fidaxomicin-treated patients, 6 (5.6%) were infected with isolates that possessed reduced fidaxomicin susceptibility (MICs 8-32 µg/mL), including 3 with initially susceptible isolates followed by clinical failure with subsequent recovery of genomically related isolates with reduced susceptibility. Isolates with reduced fidaxomicin susceptibility harbored mutations in RNA polymerase associated with reduced susceptibility and exhibited reduced toxin production, and 20% to 40% of isolates tested had reduced growth and/or sporulation in comparison with susceptible isolates. Three patients were infected with genomically indistinguishable ribotype 097 isolates with reduced fidaxomicin susceptibility.
conclusionsOur findings highlight the potential for the emergence on therapy of clinically relevant reduced fidaxomicin susceptibility in C. difficile and its spread via transmission to other patients.
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