Pan-European longitudinal surveillance of antibiotic resistance among prevalent Clostridium difficile ribotypes

Pan-European Longitudinal Surveillance of Antibiotic Resistance among Prevalent Clostridium difficile Ribotypes' Study Group

Research output: Contribution to journalArticle

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Abstract

Clostridium difficile infection remains a major healthcare burden. Until the recent introduction of fidaxomicin, antimicrobial treatments were limited to metronidazole and vancomycin. The emergence of epidemic C.difficile PCR ribotype 027 and its potential link to decreased antibiotic susceptibility highlight the lack of large-scale antimicrobial susceptibility and epidemiological data available. We report results of epidemiological and antimicrobial susceptibility investigations of C.difficile isolates collected prior to fidaxomicin introduction, establishing important baseline data. Thirty-nine sites in 22 countries submitted a total of 953 C.difficile isolates for PCR ribotyping, toxin testing, and susceptibility testing to metronidazole, vancomycin, fidaxomicin, rifampicin, moxifloxacin, clindamycin, imipenem, chloramphenicol, and tigecycline. Ninety-nine known ribotypes were identified. Ribotypes 027, 014, 001/072, and 078 were most frequently isolated in line with previous European studies. There was no evidence of resistance to fidaxomicin, and reduced susceptibility to metronidazole and vancomycin was also scarce. Rifampicin, moxifloxacin, and clindamycin resistance (13%, 40%, and 50% of total isolates, respectively) were evident in multiple ribotypes. There was a significant correlation between lack of ribotype diversity and greater antimicrobial resistance (measured by cumulative resistance score). Well-known epidemic ribotypes 027 and 001/072 were associated with multiple antimicrobial resistance, but high levels of resistance were also observed, particularly in 018 and closely related emergent ribotype 356 in Italy. This raises the possibility of antimicrobial exposure as the underlying reason for their appearance, and highlights the need for ongoing epidemiological and antimicrobial resistance surveillance.

Original languageEnglish
Pages (from-to)248.e9-248.e16
JournalClinical Microbiology and Infection
Volume21
Issue number3
DOIs
Publication statusPublished - 2015

Fingerprint

Ribotyping
Clostridium difficile
Microbial Drug Resistance
Metronidazole
Vancomycin
Clindamycin
Rifampin
Clostridium Infections
Polymerase Chain Reaction
Imipenem
Chloramphenicol
Italy
Anti-Bacterial Agents
Delivery of Health Care
lipiarmycin

Keywords

  • Antimicrobial resistance
  • Clostridium difficile
  • Epidemiology
  • PCR ribotyping
  • Surveillance

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Pan-European Longitudinal Surveillance of Antibiotic Resistance among Prevalent Clostridium difficile Ribotypes' Study Group (2015). Pan-European longitudinal surveillance of antibiotic resistance among prevalent Clostridium difficile ribotypes. Clinical Microbiology and Infection, 21(3), 248.e9-248.e16. https://doi.org/10.1016/j.cmi.2014.09.017

Pan-European longitudinal surveillance of antibiotic resistance among prevalent Clostridium difficile ribotypes. / Pan-European Longitudinal Surveillance of Antibiotic Resistance among Prevalent Clostridium difficile Ribotypes' Study Group.

In: Clinical Microbiology and Infection, Vol. 21, No. 3, 2015, p. 248.e9-248.e16.

Research output: Contribution to journalArticle

Pan-European Longitudinal Surveillance of Antibiotic Resistance among Prevalent Clostridium difficile Ribotypes' Study Group 2015, 'Pan-European longitudinal surveillance of antibiotic resistance among prevalent Clostridium difficile ribotypes', Clinical Microbiology and Infection, vol. 21, no. 3, pp. 248.e9-248.e16. https://doi.org/10.1016/j.cmi.2014.09.017
Pan-European Longitudinal Surveillance of Antibiotic Resistance among Prevalent Clostridium difficile Ribotypes' Study Group. Pan-European longitudinal surveillance of antibiotic resistance among prevalent Clostridium difficile ribotypes. Clinical Microbiology and Infection. 2015;21(3):248.e9-248.e16. https://doi.org/10.1016/j.cmi.2014.09.017
Pan-European Longitudinal Surveillance of Antibiotic Resistance among Prevalent Clostridium difficile Ribotypes' Study Group. / Pan-European longitudinal surveillance of antibiotic resistance among prevalent Clostridium difficile ribotypes. In: Clinical Microbiology and Infection. 2015 ; Vol. 21, No. 3. pp. 248.e9-248.e16.
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