Antimicrobial susceptibility and mechanisms of resistance of Greek Clostridium difficile clinical isolates

Chatedaki, Christina; Voulgaridi, Ioanna; Kachrimanidou, Melina; Hrabák, Jaroslav; Papagiannitsis, Costas C.; Petinaki, Efi

doi:10.1016/j.jgar.2018.09.009

Cited by 28 publications

(7 citation statements)

References 36 publications

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“…Plasmids may play a broader role in antimicrobial resistance of C. difficile. A putative plasmid containing the aminoglycoside/linezolid resistance gene cfrC was recently identified in silico, but in contrast to our work no experiments were presented to verify the contig was in fact a plasmid conferring resistance 54 . The presence of an antimicrobial resistance gene does not always result in resistance, and DNA-based identification of putative resistance genes without phenotypic confirmation may lead to an overestimation of the resistance frequencies 19,55,56 .…”

Section: Discussioncontrasting

confidence: 60%

Plasmid-mediated metronidazole resistance in Clostridioides difficile

et al. 2020

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Metronidazole was until recently used as a first-line treatment for potentially life-threatening Clostridioides difficile (CD) infection. Although cases of metronidazole resistance have been documented, no clear mechanism for metronidazole resistance or a role for plasmids in antimicrobial resistance has been described for CD. Here, we report genome sequences of seven susceptible and sixteen resistant CD isolates from human and animal sources, including isolates from a patient with recurrent CD infection by a PCR ribotype (RT) 020 strain, which developed resistance to metronidazole over the course of treatment (minimal inhibitory concentration [MIC] = 8 mg L −1). Metronidazole resistance correlates with the presence of a 7-kb plasmid, pCD-METRO. pCD-METRO is present in toxigenic and non-toxigenic resistant (n = 23), but not susceptible (n = 563), isolates from multiple countries. Introduction of a pCD-METRO-derived vector into a susceptible strain increases the MIC 25-fold. Our finding of plasmid-mediated resistance can impact diagnostics and treatment of CD infections.

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Section: Discussioncontrasting

confidence: 60%

Plasmid-mediated metronidazole resistance in Clostridioides difficile

et al. 2020

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“…The WHO has identified antimicrobial resistance in bacteria as one of the greatest threats to human health (World Health Organization, 2014). The occurrence of resistant bacteria in hospitals is widely recognized (Chatedaki et al, 2019), and recent studies have also documented antibiotic-resistant bacteria in the environment, including water supplies and soil (Sarmah et al, 2006;Fernando et al, 2016). Overuse of antimicrobials in agricultural settings, including animal production, and the consequent selective pressure has contributed to the build-up of resistant organisms in the environment (Levy et al, 2005;Davies and Davies, 2010;Peng et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

The novel and transferable erm(51) gene confers macrolides, lincosamides and streptogramins B (MLS_B) resistance to clonal Rhodococcus equi in the environment

Huber

Giguère

Slovis

et al. 2020

Environmental Microbiology

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Summary The use of mass antimicrobial treatment has been linked to the emergence of antimicrobial resistance in human and animal pathogens. Using whole‐genome single‐molecule real‐time (SMRT) sequencing, we characterized genomic variability of multidrug‐resistant Rhodococcus equi isolated from soil samples from 100 farms endemic for R. equi infections in Kentucky. We discovered the novel erm(51)‐encoding resistance to MLSB in R. equi isolates from soil of horse‐breeding farms. Erm(51) is inserted in a transposon (TnErm51) that is associated with a putative conjugative plasmid (pRErm51), a mobilizable plasmid (pMobErm51), or both enabling horizontal gene transfer to susceptible organisms and conferring high levels of resistance against MLSB in vitro. This new resistant genotype also carries a previously unidentified rpoB mutation conferring resistance to rifampicin. Isolates carrying both vapA and erm(51) were rarely found, indicating either a recent acquisition of erm(51) and/or impaired survival when isolates carry both genes. Isolates carrying erm(51) are closely related genetically and were likely selected by antimicrobial exposure in the environment.

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“…Notably, we also found that the resistance rates of erythromycin, rifampin, moxifloxacin and gatifloxacin in A − B + isolates were significantly higher than in A + B + isolates in children, indicating that exposures to clindamycin, erythromycin, fusidic acid, levofloxacin and ciprofloxacin might potentially exist in pediatrics in eastern China. Therefore, antimicrobial resistance mechanisms should be investigated and more antimicrobial resistance genes such as mefA, cfrB, and cfrC should be detected as the previous report [52] later in order to obtain the complete molecular characterization of the C. difficile isolates from pediatrics. Furthermore, partial C. difficile A − B + isolates led to clinical severe CDI as we previously reported [25].…”

Section: Discussionmentioning

confidence: 99%

Molecular characteristics of Clostridium difficile in children with acute gastroenteritis from Zhejiang

et al. 2020

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Background: Clostridium difficile infection (CDI) has an increasing pediatric prevalence worldwide. However, molecular characteristics of C. difficile in Chinese children with acute gastroenteritis have not been reported. Methods: A five-year cross-sectional study was conducted in a tertiary children's hospital in Zhejiang. Consecutive stool specimens from outpatient children with acute gastroenteritis were cultured for C. difficile, and isolates then were analyzed for toxin genes, multi-locus sequence type and antimicrobial resistance. Diarrhea-related viruses were detected, and demographic data were collected. Results: A total of 115 CDI cases (14.3%), and 69 co-infected cases with both viruses and toxigenic C. difficile, were found in the 804 stool samples. The 186 C. difficile isolates included 6 of toxin A-positive/toxin B-positive/binary toxin-positive (A + B + CDT +), 139 of A + B + CDT − , 3 of A − B + CDT + , 36 of A − B + CDT − and 2 of A − B − CDT −. Sequence types 26 (17.7%), 35 (11.3%), 39 (12.4%), 54 (16.7%), and 152 (11.3%) were major genotypes with significant differences among different antimicrobial resistances (Fisher's exact test, P < 0.001). The A − B + isolates had significantly higher resistance, compared to erythromycin, rifampin, moxifloxacin, and gatifloxacin, than that of the A + B + (χ 2 = 7.78 to 29.26, P < 0.01). The positive CDI rate in infants (16.2%) was significantly higher than that of children over 1 year old (10.8%) (χ 2 = 4.39, P = 0.036). Conclusions: CDI has been revealed as a major cause of acute gastroenteritis in children with various genotypes. The role of toxigenic C. difficile and risk factors of CDI should be emphatically considered in subsequent diarrhea surveillance in children from China.

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Antimicrobial susceptibility and mechanisms of resistance of Greek Clostridium difficile clinical isolates

Cited by 28 publications

References 36 publications

Plasmid-mediated metronidazole resistance in Clostridioides difficile

Plasmid-mediated metronidazole resistance in Clostridioides difficile

The novel and transferable erm(51) gene confers macrolides, lincosamides and streptogramins B (MLS_B) resistance to clonal Rhodococcus equi in the environment

Molecular characteristics of Clostridium difficile in children with acute gastroenteritis from Zhejiang

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Antimicrobial susceptibility and mechanisms of resistance of Greek Clostridium difficile clinical isolates

Cited by 28 publications

References 36 publications

Plasmid-mediated metronidazole resistance in Clostridioides difficile

Plasmid-mediated metronidazole resistance in Clostridioides difficile

The novel and transferable erm(51) gene confers macrolides, lincosamides and streptogramins B (MLSB) resistance to clonal Rhodococcus equi in the environment

Molecular characteristics of Clostridium difficile in children with acute gastroenteritis from Zhejiang

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The novel and transferable erm(51) gene confers macrolides, lincosamides and streptogramins B (MLS_B) resistance to clonal Rhodococcus equi in the environment