{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T01:43:47Z","timestamp":1790819027757,"version":"4.1.0"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2021,12,11]],"date-time":"2021-12-11T00:00:00Z","timestamp":1639180800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01AI116914"],"award-info":[{"award-number":["R01AI116914"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01AI150685"],"award-info":[{"award-number":["R01AI150685"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["T32AI055449"],"award-info":[{"award-number":["T32AI055449"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["K24AI121296"],"award-info":[{"award-number":["K24AI121296"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["P01-AI152999-01"],"award-info":[{"award-number":["P01-AI152999-01"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R01-AI148342-01"],"award-info":[{"award-number":["R01-AI148342-01"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R01-AI134637"],"award-info":[{"award-number":["R01-AI134637"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Texas Medical Center Digestive Diseases Center","award":["DK56338"],"award-info":[{"award-number":["DK56338"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,1,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Clostridioides difficile infection (CDI) is a leading cause of hospital-associated antibiotic-related diarrhea and deaths worldwide. Vancomycin is one of the few antibiotics recommended for both nonsevere and severe CDI cases. We sought to determine whether vancomycin nonsusceptible C. difficile strains are circulating in the patient population.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Stool samples from patients with CDI were collected from 438 and 98 patients at a large university hospital in Houston, Texas, and Nairobi, Kenya, respectively. The stools were examined for the presence of vancomycin and metronidazole nonsusceptible C. difficile using broth dilution culture, Etest (BioM\u00e9rieux, France), polymerase chain reaction (PCR), whole-genome sequencing, and in vivo testing in a CDI mouse model.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of the Houston stool samples, 114\/438 (26%) had vancomycin nonsusceptible C. difficile isolates and 128\/438 (29%) were metronidazole nonsusceptible. Similarly, 66 out of 98 (67%) and 83\/98 (85%) of the Nairobi patients harbored vancomycin and metronidazole nonsusceptible isolates, respectively. Vancomycin treatment of a CDI mouse model infected with a vancomycin nonsusceptible isolate failed to eradicate the infection. Whole-genome sequencing analyses did not identify vanA genes, suggesting a different mechanism of resistance.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>C. difficile strains exhibiting reduced susceptibility to vancomycin are currently circulating in patient populations. The spread of strains resistance to vancomycin, a first-line antibiotic for CDI, poses a serious therapeutic challenge. Routine susceptibility testing may be necessary.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciaa912","type":"journal-article","created":{"date-parts":[[2020,6,27]],"date-time":"2020-06-27T06:50:08Z","timestamp":1593240608000},"page":"120-126","source":"Crossref","is-referenced-by-count":54,"title":["Emergence of Clinical <i>Clostridioides difficile<\/i> Isolates With Decreased Susceptibility to Vancomycin"],"prefix":"10.1093","volume":"74","author":[{"given":"Charles","family":"Darkoh","sequence":"first","affiliation":[{"name":"University of Texas Health Science Center, School of Public Health, Department of Epidemiology, Human Genetics, and Environmental Sciences, Center for Infectious Diseases, Houston, Texas,USA"},{"name":"University of Texas MD Anderson Cancer Center, UTHealth Graduate School of Biomedical Sciences, Microbiology and Infectious Diseases Program, Houston, Texas,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kadiatou","family":"Keita","sequence":"additional","affiliation":[{"name":"Alabama A&M University, Huntsville, Alabama, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chioma","family":"Odo","sequence":"additional","affiliation":[{"name":"University of Texas MD Anderson Cancer Center, UTHealth Graduate School of Biomedical Sciences, Microbiology and Infectious Diseases Program, Houston, Texas,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Micah","family":"Oyaro","sequence":"additional","affiliation":[{"name":"University of Nairobi, School of Medicine, College of Health Sciences, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric L","family":"Brown","sequence":"additional","affiliation":[{"name":"University of Texas Health Science Center, School of Public Health, Department of Epidemiology, Human Genetics, and Environmental Sciences, Center for Infectious Diseases, Houston, Texas,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cesar A","family":"Arias","sequence":"additional","affiliation":[{"name":"University of Texas Health Science Center, School of Public Health, Department of Epidemiology, Human Genetics, and Environmental Sciences, Center for Infectious Diseases, Houston, Texas,USA"},{"name":"University of Texas MD Anderson Cancer Center, UTHealth Graduate School of Biomedical Sciences, Microbiology and Infectious Diseases Program, Houston, Texas,USA"},{"name":"Division of Infectious Diseases and Center for Antimicrobial Resistance and Microbial Genomics, UTHealth, McGovern School of Medicine at Houston, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blake M","family":"Hanson","sequence":"additional","affiliation":[{"name":"University of Texas Health Science Center, School of Public Health, Department of Epidemiology, Human Genetics, and Environmental Sciences, Center for Infectious Diseases, Houston, Texas,USA"},{"name":"Division of Infectious Diseases and Center for Antimicrobial Resistance and Microbial Genomics, UTHealth, McGovern School of Medicine at Houston, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Herbert L","family":"DuPont","sequence":"additional","affiliation":[{"name":"University of Texas Health Science Center, School of Public Health, Department of Epidemiology, Human Genetics, and Environmental Sciences, Center for Infectious Diseases, Houston, Texas,USA"},{"name":"University of Texas MD Anderson Cancer Center, UTHealth Graduate School of Biomedical Sciences, Microbiology and Infectious Diseases Program, Houston, Texas,USA"},{"name":"Kelsey Research Foundation, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,12,11]]},"reference":[{"key":"2022011123254613300_CIT0001","doi-asserted-by":"crossref","first-page":"1394","DOI":"10.1111\/jgs.12378","article-title":"Fecal transplantation for recurrent Clostridium difficile infection in older adults: a review","volume":"61","author":"Burke","year":"2013","journal-title":"J Am Geriatr Soc"},{"key":"2022011123254613300_CIT0002","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/cid\/cix1085","article-title":"Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA)","volume":"66","author":"McDonald","year":"2018","journal-title":"Clin Infect Dis"},{"issue":"Suppl 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