A nationwide study of molecular epidemiology and antimicrobial susceptibility of Clostridioides difficile in South Korea

Byun, Jung Hyun; Kim, Heejung; Kim, Jung Lim; Kim, Do Kyun; Jeong, Seok Hoon; Shin, Jeong Hwan; Kim, Young Ah; Shin, Jong Hee; Shin, Kyeong Seob; Uh, Young

doi:10.1016/j.anaerobe.2019.102106

Cited by 18 publications

(13 citation statements)

References 38 publications

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“…In previous studies, use of piperacillin/tazobactam was associated with a lower risk of C. difficile colonization and CDI, compared with the consumption of third-generation cephalosporins [ 23 – 27 ]. In studies that reported on the antibiotic susceptibility of C. difficile strains in Korea, almost all isolated C. difficile strains were susceptible to piperacillin/tazobactam, while approximately half of C. difficile isolates were resistant to ampicillin [ 29 , 30 ]. The antibiotic susceptibility of C. difficile may influence the occurrence of HO-CDI.…”

Section: Discussionmentioning

confidence: 99%

Correlation between antibiotic consumption and the incidence of healthcare facility-onset Clostridioides difficile infection: a retrospective chart review and analysis

Yun

Park

2021

Antimicrob Resist Infect Control

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Background Healthcare facility-onset Clostridioides difficile infection is the leading cause of antibiotic-associated diarrhea, and is associated with morbidity and mortality. The use of antibiotics is an important risk factor for healthcare facility-onset C. difficile infection. We evaluated the correlation between the incidence of healthcare facility-onset C. difficile infection and antibiotic consumption, according to antibiotic class. Methods Patients with healthcare facility-onset C. difficile infection from January 2017 to December 2018 at Konkuk University Medical Center (a tertiary medical center) were included. We evaluated changes in the incidence of healthcare facility-onset C. difficile infection and antibiotic consumption. The correlation between the incidence of healthcare facility-onset C. difficile infection and antibiotic consumption was evaluated two ways: without a time interval and with 1-month interval matching. Results A total of 446 episodes of healthcare facility-onset C. difficile infection occurred during the study period. The incidence of healthcare facility-onset C. difficile infection was 9.3 episodes per 10,000 patient-days, and increased significantly. We observed an increase in the consumption of β-lactam/β-lactamase inhibitors, and a decrease in the consumption of other classes of antibiotics, with a significant decrease in the consumption of fluoroquinolones, glycopeptides, and clindamycin (P = 0.01, P < 0.001, and P = 0.001, respectively). The consumption of β-lactam/β-lactamase inhibitors was independently correlated with the incidence of healthcare facility-onset C. difficile infection in the analysis without a time interval. When the analysis was conducted with 1-month interval matching, glycopeptide consumption was independently associated with the incidence of healthcare facility-onset C. difficile infection. Conclusions Despite the reduction in fluoroquinolone and clindamycin consumption, the incidence of healthcare facility-onset C. difficile infection increased during the study period, and was correlated with increased consumption of β-lactam/β-lactamase inhibitors. Reduced consumption of specific antibiotics may be insufficient to reduce the incidence of healthcare facility-onset C. difficile infection.

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Section: Discussionmentioning

confidence: 99%

Correlation between antibiotic consumption and the incidence of healthcare facility-onset Clostridioides difficile infection: a retrospective chart review and analysis

Yun

Park

2021

Antimicrob Resist Infect Control

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“…Prevalence of the RT027 strain in both the United States and Canada fell between 2011 and 2015 ( Public Health Agency of Canada, 2017 ; CDC, 2019 ). Multiple outbreaks of CDI caused by the RT027/ST1 strain were driven by fluoroquinolone and rifampicin resistance ( Imwattana et al, 2020 ; Lew et al, 2020 ), and a fall in its prevalence reported in England in 2010 likely resulted from restricted use of fluoroquinolones ( Byun et al, 2019 ).…”

Section: Discussionmentioning

confidence: 99%

“…Prevalence of the RT027 strain in both the United States and Canada fell between (Public Health Agency of Canada, 2017CDC, 2019). Multiple outbreaks of CDI caused by the RT027/ST1 strain were driven by fluoroquinolone and rifampicin resistance (Imwattana et al, 2020;Lew et al, 2020), and a fall in its prevalence reported in England in 2010 likely resulted from restricted use of fluoroquinolones (Byun et al, 2019). Interestingly, no RT027 strain was detected in Lebanon (Berger et al, 2018), and a multi-center study of C. difficile isolates in China reported only one RT027/ST1 isolate within the most predominant STs represented by clade 1 (Liu et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

“…In 2005 and 2008, 17.2 and 23% of all toxinogenic isolates collected in 14 and 34 European countries, respectively, were binary toxin-positive (Barbut et al, 2007;Bauer et al, 2011). By contrast, binary toxin-positive strains of C. difficile were detected rarely in South Korea (Byun et al, 2019) and 13 other Asia-Pacific countries (Collins et al, 2020). In Iran, 12.4% of C. difficile strains were binary toxin-positive (Azimirad et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

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High Prevalence of Genetically Related Clostridium Difficile Strains at a Single Hemato-Oncology Ward Over 10 Years

et al. 2020

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Aims: Clostridium difficile ( C. difficile ) infection (CDI) is the main cause of healthcare-associated infectious diarrhea. We used whole-genome sequencing (WGS) to measure the prevalence and genetic variability of C. difficile at a single hemato-oncology ward over a 10 year period. Methods: Between 2008 and 2018, 2077 stool samples were obtained from diarrheal patients hospitalized at the Department of Lymphoma; of these, 618 were positive for toxin A/B. 140 isolates were then subjected to WGS on Ion Torrent PGM sequencer. Results: 36 and 104 isolates were recovered from 36 to 46 patients with single and multiple CDIs, respectively. Of these, 131 strains were toxigenic. Toxin gene profiles tcdA(+);tcdB(+);cdtA/cdtB(+) and tcdA(+);tcdB(+);cdtA/cdtB(-) were identified in 122 and nine strains, respectively. No isolates showed reduced susceptibility to metronidazole and vancomycin. All tested strains were resistant to ciprofloxacin, and 72.9, 42.9, and 72.9% of strains were resistant to erythromycin, clindamycin, or moxifloxacin, respectively. Multi-locus sequence typing (MLST) identified 23 distinct sequence types (STs) and two unidentified strains. Strains ST1 and ST42 represented 31 and 30.1% of all strains tested, respectively. However, while ST1 was detected across nearly all years studied, ST42 was detected only from 2009 to 2011. Conclusion: The high proportion of infected patients in 2008–2011 may be explained by the predominance of more transmissible and virulent C. difficile strains. Although this retrospective study was not designed to define outbreaks of C. difficile , the finding that most isolates exhibited high levels of genetic relatedness suggests nosocomial acquisition.

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“…Moreover, the weighted pooled resistance rates of studies conducted before and after 2012 were 2.5%, and 1.7%, respectively. Several studies conducted in Korea also showed a 0.0% resistance rate for metronidazole [ 30 31 32 ]. Only one study had reported a 2.9% metronidazole resistance rate [ 33 ].…”

Section: Considerations When Choosing Metronidazole Treatmentmentioning

confidence: 99%

Which is the Preferred Regimen for Non-Severe Clostridioides difficile Infection in Korea, Vancomycin or Metronidazole?

Kim

et al. 2022

Infect Chemother

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The emergence of hypervirulent Clostridioides difficile strains has decreased the efficacy of metronidazole in the treatment of C. difficile infection (CDI). Therefore, revised guidelines no longer recommend the use of metronidazole as a first-line regimen for CDI and restrict its use for non-severe CDI, only when vancomycin and fidaxomicin are unavailable. In Korea, an epidemic caused by a hypervirulent C. difficile strain or the emergence of metronidazole resistant C. difficile strains have not been reported. This review article aims to compare the treatment outcomes and adverse effects of vancomycin and metronidazole and discuss the validity of the guidelines of various agencies, which restrict the use of metronidazole, for Korean patients. There are no substantial adverse effects of metronidazole, and its clinical outcomes against non-severe CDI are similar to those of vancomycin. Based on these findings, we recommend that the use of metronidazole for the treatment of non-severe CDI is still an appropriate option in Korea.

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A nationwide study of molecular epidemiology and antimicrobial susceptibility of Clostridioides difficile in South Korea

Cited by 18 publications

References 38 publications

Correlation between antibiotic consumption and the incidence of healthcare facility-onset Clostridioides difficile infection: a retrospective chart review and analysis

Correlation between antibiotic consumption and the incidence of healthcare facility-onset Clostridioides difficile infection: a retrospective chart review and analysis

High Prevalence of Genetically Related Clostridium Difficile Strains at a Single Hemato-Oncology Ward Over 10 Years

Which is the Preferred Regimen for Non-Severe Clostridioides difficile Infection in Korea, Vancomycin or Metronidazole?

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