Fluoroquinolone and Macrolide Exposure Predict Clostridium difficile Infection with the Highly Fluoroquinolone- and Macrolide-Resistant Epidemic C. difficile Strain BI/NAP1/027

Wieczorkiewicz, Jeffrey T.; Lopansri, Bert K.; Cheknis, Adam; Osmolski, James R.; Hecht, David W.; Gerding, Dale N.; Johnson, Stuart

doi:10.1128/aac.01820-15

Cited by 49 publications

(28 citation statements)

References 21 publications

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“…The epidemic REA group BI was the most common strain at our hospital 3 to 4 years prior to this study accounting for 72% of first CDI episodes. 10 We noted a progressive decrease in the percentage of BI during the transition from MST testing to NAAT testing in this study. After MST had been in place for nearly a year, the number of stools tested were nearly identical (85.7 and 80.3 per month for MST-A and -B periods, respectively), but the number of positive C. difficile decreased by 30.3% (P = .005).…”

Section: Discussionsupporting

confidence: 56%

“…The BI 6/8/17 subgroup was the most frequently identified BI subgroup before and after the change in testing, consistent with previous epidemiological studies at our institution. 10 Representative C. difficile isolates from each REA group before and after the implementation of MST were analyzed for quantitative toxin production in vitro (Fig. 3).…”

Section: Resultsmentioning

confidence: 99%

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Sequential introduction of a multistep testing algorithm and nucleic acid amplification testing leading to an increase in Clostridioides difficile detection and a trend toward increased strain diversity

Skinner

Cheknis

et al. 2020

Infect. Control Hosp. Epidemiol.

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Background: Most clinical microbiology laboratories have replaced toxin immunoassay (EIA) alone with multistep testing (MST) protocols or nucleic acid amplification testing (NAAT) alone for the detection of C. difficile. Objective: Study the effect of changing testing strategies on C. difficile detection and strain diversity. Design: Retrospective study. Setting: A Veterans’ Affairs hospital. Methods: Initially, toxin EIA testing was replaced by an MST approach utilizing a glutamate dehydrogenase (GDH) and toxin EIA followed by tcdB NAAT for discordant results. After 18 months, MST was replaced by a NAAT-only strategy. Available patient stool specimens were cultured for C. difficile. Restriction endonuclease analysis (REA) strain typing and quantitative in vitro toxin testing were performed on recovered isolates. Results: Before MST (toxin EIA), 79 of 708 specimens (11%) were positive, and after MST (MST-A), 121 of 517 specimens (23%) were positive (P < .0001). Prior to NAAT-only testing (MST-B), 80 of the 490 specimens (16%) were positive by MST, and after NAAT-only testing was implemented, 67 of the 368 specimens (18%) were positive (P = nonsignificant). After replacing toxin EIA testing, REA strain group diversity increased (8, 13, 13, and 10 REA groups in the toxin EIA, MST-A, MST-B, and NAAT-only periods, respectively) and in vitro toxin concentration decreased. The average log10 toxin concentration of the isolates were 2.08, 1.88, 1.20 and 1.55 ng/mL for the same periods, respectively. Conclusions: MST and NAAT had similar detection rates for C. difficile. Compared to toxin testing alone, they detected increased diversity of C. difficile strains, many of which were low toxin producing.

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Section: Discussionsupporting

confidence: 56%

Section: Resultsmentioning

confidence: 99%

Sequential introduction of a multistep testing algorithm and nucleic acid amplification testing leading to an increase in Clostridioides difficile detection and a trend toward increased strain diversity

Skinner

Cheknis

et al. 2020

Infect. Control Hosp. Epidemiol.

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“…A detailed test method, interpretive categories, and breakpoints have been described in the CLSI document M100 (52). There have been plenty of C. difficile studies employing the agar dilution assay to test antimicrobial susceptibility (18,21,53,54). In addition, the agar dilution assay is always chosen as a reference method to which other AST methods are compared (55).…”

Section: Role Of Antimicrobial Susceptibility Testing Of Clostridium mentioning

confidence: 99%

Update on Antimicrobial Resistance in Clostridium difficile: Resistance Mechanisms and Antimicrobial Susceptibility Testing

et al. 2017

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Oral antibiotics such as metronidazole, vancomycin and fidaxomicin are therapies of choice for infection. Several important mechanisms for antibiotic resistance have been described, including the acquisition of antibiotic resistance genes via the transfer of mobile genetic elements, selective pressure resulting in gene mutations, altered expression of redox-active proteins, iron metabolism, and DNA repair, as well as via biofilm formation. This update summarizes new information published since 2010 on phenotypic and genotypic resistance mechanisms in and addresses susceptibility test methods and other strategies to counter antibiotic resistance of .

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“…No specific antimicrobial drug was highly associated with infection by this strain. Fluoroquinolones have been associated with CDI outbreaks with the BI/ RT027 strain, which is highly resistant to fluoroquinolones in vitro (35). Among the DQ/RT591-and BI/ RT027-infected patients, receipt of fluoroquinolones or clindamycin was limited.…”

Section: Discussionmentioning

confidence: 99%

Unique Clindamycin-Resistant Clostridioidesdifficile Strain Related to Fluoroquinolone-Resistant Epidemic BI/RT027 Strain

Skinner¹,

Petrella²,

Siddiqui³

et al. 2020

Emerg. Infect. Dis.

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Fluoroquinolone and Macrolide Exposure Predict Clostridium difficile Infection with the Highly Fluoroquinolone- and Macrolide-Resistant Epidemic C. difficile Strain BI/NAP1/027

Abstract: Antibiotics have been shown to influence the risk of infection with specific

Cited by 49 publications

References 21 publications

Sequential introduction of a multistep testing algorithm and nucleic acid amplification testing leading to an increase in Clostridioides difficile detection and a trend toward increased strain diversity

Sequential introduction of a multistep testing algorithm and nucleic acid amplification testing leading to an increase in Clostridioides difficile detection and a trend toward increased strain diversity

Update on Antimicrobial Resistance in Clostridium difficile: Resistance Mechanisms and Antimicrobial Susceptibility Testing

Unique Clindamycin-Resistant Clostridioidesdifficile Strain Related to Fluoroquinolone-Resistant Epidemic BI/RT027 Strain

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