Antibiotic susceptibility of Clostridium difficile is similar worldwide over two decades despite widespread use of broad-spectrum antibiotics: an analysis done at the University Hospital of Zurich

Abstract

BackgroundClostridium difficile infection (CDI) remains a major health problem worldwide. Antibiotic use, in general, and clindamycin and ciprofloxacin, in particular, have been implicated in the pathogenesis of CDI. Here, we hypothesized that antibiotics that are highly active in vitro against C. difficile are less frequently associated with CDI than others. The primary goals of our study were to determine if antibiotic susceptibility and CDI are associated and whether the antimicrobial susceptibility of C. difficile changed over the years.Methods and resultsWe examined a large panel of C. difficile strains collected in 2006-2008 at the University Hospital of Zurich. We found that the antimicrobial susceptibilities to amoxicillin/clavulanate, piperacillin/tazobactam, meropenem, clindamycin, ciprofloxacin, ceftriaxone, metronidazole and vancomycin were similar to those reported in the literature and that they are similar to those reported in other populations over the last two decades. Antibiotic activity did not prevent CDI. For example, thre use of meropenem, which is highly active against all strains tested, was a clear risk factor for CDI. Most of the antibiotics tested also showed a higher minimum inhibitory concentration distribution than that of EUCAST. All strains were susceptible to metronidazole. One strain was resistant to vancomycin.ConclusionsAntibiotic susceptibilities of the collection of C. difficile from the University Hospital of Zurich are similar to those reported by others since the 1980. Patients treated with carbapenems and cephalosporins had the highest risk of developing CDI irrespective of the antimicrobial activity of carbapenems.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0607-z) contains supplementary material, which is available to authorized users.

Antibiotic susceptibility and resistance profiles of Romanian Clostridioides difficile isolates

“…As most MLS B -resistant isolates were ermB-negative and no chloramphenicol-resistant isolates showed presence of catD, molecular resistance mechanisms against these antibiotics remain unclear and are to be analysed more thoroughly in future studies. The findings in the present study support the assertion that extensive administration of rifampin, carbapenems such as imipenem, fluoroquinolones, cephalosporins or MLS B [6,15,21,40,41], could involve high risk of CDI development and emergence of outbreaks, especially with epidemic PRs 027 or 017. In contrast, taking into consideration antibiotics demonstrated to be highly active against C. difficile, when selecting treatment for various types of infections, could contribute to minimising the risk of CDI spread.…”

“…In conclusion, the clinical isolates analysed in this study have high levels of antimicrobial resistance, especially to wide-spectrum antibiotics representing cephalosporins, MLS B , rifampins, fluoroquinolones and carbapenems, considered risk factors for development of C. difficile infection, along with advanced age and hospitalization [1,8,10,40]. Multi-drug resistance may be attributed to the majority of isolates, resistant to at least five classes of antibiotics [13].…”

Randomized clinical trial to evaluate the effect of fecal microbiota transplant for initial Clostridium difficile infection in intestinal microbiome

“…Previously reported breakpoints were considered for ciprofloxacin [ 14 ], linezolid [ 15 ], and rifampicin [ 16 ]. Vancomycin breakpoints were those from the EUCAST Clinical Breakpoint Tables v. 6.0, 2016, and the breakpoints of the other antimicrobials were obtained from the clinical CLSI guideline M100-S26 [ 17 ].…”

Role of cephalosporins in the era ofClostridium difficileinfection

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