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Peer-reviewedCC BY 4.0Antimicrobial Agents and Chemotherapy

Case Commentary: Emergence of clinically relevant fidaxomicin-resistant Clostridioides difficile strains

  • Kevin W. Garey1
  • Julian G. Hurdle2,3
  1. 1Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas, USA
  2. 2Center for Infectious and Inflammatory Diseases, Institute of Biosciences and Technology, Houston, Texas, USA
  3. 3Department of Translational Medical Sciences, Naresh K. Vashisht College of Medicine, Texas A&M University, Houston, Texas, USA
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Abstract

Clostridioides difficile infection (CDI) has limited antibiotic treatment options, with fidaxomicin being the guideline-preferred antibiotic. C. E. Kaple, S. N. Redmond, J. L. Cadum, B. Hausman, et al. (Antimicrob Agents Chemother 0:e00130-26, 2026, https://doi.org/10.1128/aac.00130-26) describe a case of clinical failure in an elderly patient with CDI treated with a pulsed-taper fidaxomicin regimen, in which the MIC increased from 0.05 μg/mL at baseline to 32 μg/mL in isolates recovered during relapse. Relapsing symptoms were eventually resolved only after switching to oral vancomycin. This case, together with other recent clinical reports, may be the tip of the iceberg, signaling that fidaxomicin-resistant C. difficile can arise during treatment and contribute to clinical failure. It further challenges the assumption that high colonic drug concentrations mitigate resistance and underscores the need for improved surveillance and the development of clinically applicable molecular diagnostics to detect fidaxomicin resistance in CDI patient samples.

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Cite

BibTeXRIS
BibTeX
@article{garey2026case,
  title = {{Case Commentary: Emergence of clinically relevant fidaxomicin-resistant Clostridioides difficile strains}},
  author = {Kevin W. Garey and Julian G. Hurdle},
  journal = {Antimicrobial Agents and Chemotherapy},
  year = {2026},
  month = aug,
  doi = {10.1128/aac.00482-26},
  url = {https://doi.org/10.1128/aac.00482-26},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Case Commentary: Emergence of clinically relevant fidaxomicin-resistant Clostridioides difficile strains
AU  - Kevin W. Garey
AU  - Julian G. Hurdle
PY  - 2026
DA  - 2026/08/03
JO  - Antimicrobial Agents and Chemotherapy
DO  - 10.1128/aac.00482-26
UR  - https://doi.org/10.1128/aac.00482-26
AB  - Clostridioides difficile infection (CDI) has limited antibiotic treatment options, with fidaxomicin being the guideline-preferred antibiotic. C. E. Kaple, S. N. Redmond, J. L. Cadum, B. Hausman, et al. (Antimicrob Agents Chemother 0:e00130-26, 2026, https://doi.org/10.1128/aac.00130-26) describe a case of clinical failure in an elderly patient with CDI treated with a pulsed-taper fidaxomicin regimen, in which the MIC increased from 0.05 μg/mL at baseline to 32 μg/mL in isolates recovered during relapse. Relapsing symptoms were eventually resolved only after switching to oral vancomycin. This case, together with other recent clinical reports, may be the tip of the iceberg, signaling that fidaxomicin-resistant C. difficile can arise during treatment and contribute to clinical failure. It further challenges the assumption that high colonic drug concentrations mitigate resistance and underscores the need for improved surveillance and the development of clinically applicable molecular diagnostics to detect fidaxomicin resistance in CDI patient samples.
SN  - 0066-4804
SN  - 1098-6596
ER  -