Clinical outcomes of Clostridium difficile infection according to strain type. A prospective study in medical wards

Serafino, S.; Consonni, Dario; Amicis, Margherita Migone De; Sisto, Francesca; Domeniconi, G.; Formica, S.; Zarantonello, M; Maraschini, Anna; Cappellini, Maria Domenica; Spigaglia, Patrizia; Barbanti, Fabrizio; Castaldi, Silvana; Gavarini, Fabio

doi:10.1016/j.ejim.2018.03.015

Cited by 7 publications

(4 citation statements)

References 26 publications

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“…[118][119][120] It tends to affect older patients and produce higher levels of toxin. [121][122][123] Patients with RT 018 had higher C-reactive protein and greater 90-day all-cause mortality in a prospective Italian cohort study, as compared with the other identified RTs. 122 The vast majority, 95.7%, of nosocomial transmission cases in one study were caused by RT 018.…”

Section: Emerging Strains and Epidemic Ribotypesmentioning

confidence: 99%

“…[121][122][123] Patients with RT 018 had higher C-reactive protein and greater 90-day all-cause mortality in a prospective Italian cohort study, as compared with the other identified RTs. 122 The vast majority, 95.7%, of nosocomial transmission cases in one study were caused by RT 018. 123 In Korean studies, RT 018 affected more female patients, caused more azotemia and more severe CDI than the next most common strain, RT 017, but increased recurrence or mortality were not observed.…”

Section: Emerging Strains and Epidemic Ribotypesmentioning

confidence: 99%

See 1 more Smart Citation

Clostridium difficile Infection: An Epidemiology Update

Roo

Regenbogen

2020

Clinics in Colon and Rectal Surgery

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Clostridium (reclassified as “Clostridioides”) difficile infection (CDI) is a healthcare-associated infection and significant source of potentially preventable morbidity, recurrence, and death, particularly among hospitalized older adults. Additional risk factors include antibiotic use and severe underlying illness. The increasing prevalence of community-associated CDI is gaining recognition as a novel source of morbidity in previously healthy patients. Even after recovery from initial infection, patients remain at risk for recurrence or reinfection with a new strain. Some pharmaco-epidemiologic studies have suggested an increased risk associated with proton pump inhibitors and protective effect from statins, but these findings have not been uniformly reproduced in all studies. Certain ribotypes of C. difficile, including the BI/NAP1/027, 106, and 018, are associated with increased antibiotic resistance and potential for higher morbidity and mortality. CDI remains a high-morbidity healthcare-associated infection, and better understanding of ribotypes and medication risk factors could help to target treatment, particularly for patients with high recurrence risk.

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Section: Emerging Strains and Epidemic Ribotypesmentioning

confidence: 99%

Section: Emerging Strains and Epidemic Ribotypesmentioning

confidence: 99%

Clostridium difficile Infection: An Epidemiology Update

Roo

Regenbogen

2020

Clinics in Colon and Rectal Surgery

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“…Over the last 30 years, unrestricted antimicrobial use has selected multidrug-resistant (MDR) C. difficile lineages, which can be identified by multilocus sequence type (ST) and/or PCR ribotype ( 2 – 9 ). Uncontrolled prescribing of antimicrobials such as fluoroquinolones and cephalosporins, which are associated with a high risk of C. difficile infection (CDI), creates conditions under which MDR lineages can cause persistent, high-mortality (≥20%) outbreaks ( 9 – 18 ). Such health care-associated transmission may be geographically widespread, as in the “hypervirulent” ST1 ribotype 027 [ST1(027)] lineage FQ-R1 ( 19 ), and/or prolonged, as in ST17(018), predominating in Japanese and Italian health care settings since the 1990s ( 17 , 20 ).…”

Section: Introductionmentioning

confidence: 99%

Penicillin Binding Protein Substitutions Cooccur with Fluoroquinolone Resistance in Epidemic Lineages of Multidrug-Resistant Clostridioides difficile

Dingle

Freeman

Didelot

et al. 2023

mBio

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“…Over the last 30 years, unrestricted antimicrobial use has selected multidrug resistant (MDR) C. difficile lineages, which can be identified by multilocus sequence type (ST) and/or PCRribotype (2)(3)(4)(5)(6)(7)(8)(9). Uncontrolled prescribing of antimicrobials such as fluoroquinolones and cephalosporins, which are associated with a high risk of C. difficile infection (CDI), creates conditions under which MDR lineages can cause persistent, high-mortality (≥20%) outbreaks (9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Such healthcare-associated transmission may be geographically widespread as in the 'hypervirulent' ST1(ribotype 027) lineage FQ-R1 (19), and/or prolonged, as in ST17(018), predominating in Japanese and Italian healthcare settings since the 1990s (17,20).…”

Section: Introductionmentioning

confidence: 99%

Penicillin Binding Protein Substitutions Co-occur with Fluoroquinolone Resistance in ‘Epidemic’ Lineages of Multi Drug-Resistant Clostridioides difficile

Dingle

Freeman²,

Didelot

et al. 2022

Preprint

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Clostridioides difficile remains a key cause of healthcare-associated infection, with multi-drug-resistant (MDR) lineages causing high mortality (≥20%) outbreaks. Cephalosporin treatment is a long-established risk factor, and antimicrobial stewardship a key control. A mechanism underlying raised cephalosporin MICs has not been identified in C. difficile, but among other species resistance is often acquired via amino acid substitutions in cell wall transpeptidases (penicillin binding proteins, PBPs). Here, we investigated five C. difficile transpeptidases (PBP1-5) for recent substitutions. Previously published genome assemblies (n=7096) were obtained, representing sixteen geographically widespread lineages, including healthcare-associated MDR ST1(027), ST3(001) and ST17(018). Recent amino acid substitutions were found within PBP1 (n=50) and PBP3 (n=48), ranging from 1-10 substitutions per genome. β-lactam MICs were measured for closely related pairs of wild-type and PBP substituted isolates separated by 20-273 SNPs. Recombination-corrected, dated phylogenies were constructed to date substitution acquisition. Key substitutions such as PBP3 V497L and PBP1 T674I/N/V emerged independently across multiple lineages. They were associated with extremely high cephalosporin MICs; 1-4 doubling dilutions wild-type up to ≤1506μg/ml. Substitution patterns varied by lineage and clade, showed geographic structure, and notably occurred post-1990, coincident with the acquisition of gyrA/B substitutions conferring fluoroquinolone resistance. In conclusion, recent PBP1 and PBP3 substitutions are associated with raised cephalosporin MICs in C. difficile. The co-occurrence of resistance to cephalosporins and fluoroquinolones hinders attempts to understand their relative importance in the dissemination of epidemic lineages. Further controlled studies of cephalosporin and fluoroquinolone stewardship are needed to determine their relative effectiveness in outbreak control.

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Clinical outcomes of Clostridium difficile infection according to strain type. A prospective study in medical wards

Cited by 7 publications

References 26 publications

Clostridium difficile Infection: An Epidemiology Update

Clostridium difficile Infection: An Epidemiology Update

Penicillin Binding Protein Substitutions Cooccur with Fluoroquinolone Resistance in Epidemic Lineages of Multidrug-Resistant Clostridioides difficile

Penicillin Binding Protein Substitutions Co-occur with Fluoroquinolone Resistance in ‘Epidemic’ Lineages of Multi Drug-Resistant Clostridioides difficile

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