Increasing antibiotic resistance in Clostridioides difficile: A systematic review and meta-analysis

Saha, Srishti; Kapoor, Saloni; Tariq, Raseen; Schuetz, Audrey N.; Tosh, Pritish K.; Pardi, Darrell S.; Khanna, Sahil

doi:10.1016/j.anaerobe.2019.102072

Cited by 52 publications

(45 citation statements)

References 79 publications

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“…Recently, a systematic review and meta-analysis [131] of metronidazole and vancomycin resistance in C. difficile showed higher WPRs than observed in our study; 1.9% (95% CI, 0.5-3.6%) for metronidazole and 2.1% (95% CI, 0-5.1%) for vancomycin. The analyses differed in the date of publication for data collection, (1982-2017) vs (1992-2019), and in the origin of the isolates since, in our analyses, the data on the C. difficile isolates of animal origin were not included.…”

Section: Discussioncontrasting

confidence: 57%

Antimicrobial resistance in Clostridioides (Clostridium) difficile derived from humans: a systematic review and meta-analysis

Sholeh

Krutova

Forouzesh

et al. 2020

Antimicrob Resist Infect Control

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Background Clostridioides (Clostridium) difficile is an important pathogen of healthcare- associated diarrhea, however, an increase in the occurrence of C. difficile infection (CDI) outside hospital settings has been reported. The accumulation of antimicrobial resistance in C. difficile can increase the risk of CDI development and/or its spread. The limited number of antimicrobials for the treatment of CDI is matter of some concern. Objectives In order to summarize the data on antimicrobial resistance to C. difficile derived from humans, a systematic review and meta-analysis were performed. Methods We searched five bibliographic databases: (MEDLINE [PubMed], Scopus, Embase, Cochrane Library and Web of Science) for studies that focused on antimicrobial susceptibility testing in C. difficile and were published between 1992 and 2019. The weighted pooled resistance (WPR) for each antimicrobial agent was calculated using a random- effects model. Results A total of 111 studies were included. The WPR for metronidazole and vancomycin was 1.0% (95% CI 0–3%) and 1% (95% CI 0–2%) for the breakpoint > 2 mg/L and 0% (95% CI 0%) for breakpoint ≥32 μg/ml. Rifampin and tigecycline had a WPRs of 37.0% (95% CI 18–58%) and 1% (95% CI 0–3%), respectively. The WPRs for the other antimicrobials were as follows: ciprofloxacin 95% (95% CI 85–100%), moxifloxacin 32% (95% CI 25–40%), clindamycin 59% (95% CI 53–65%), amoxicillin/clavulanate 0% (0–0%), piperacillin/tazobactam 0% (0–0%) and ceftriaxone 47% (95% CI 29–65%). Tetracycline had a WPR 20% (95% CI 14–27%) and meropenem showed 0% (95% CI 0–1%); resistance to fidaxomicin was reported in one isolate (0.08%). Conclusion Resistance to metronidazole, vancomycin, fidaxomicin, meropenem and piperacillin/tazobactam is reported rarely. From the alternative CDI drug treatments, tigecycline had a lower resistance rate than rifampin. The high-risk antimicrobials for CDI development showed a high level of resistance, the highest was seen in the second generation of fluoroquinolones and clindamycin; amoxicillin/clavulanate showed almost no resistance. Tetracycline resistance was present in one fifth of human clinical C. difficile isolates.

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Section: Discussioncontrasting

confidence: 57%

Antimicrobial resistance in Clostridioides (Clostridium) difficile derived from humans: a systematic review and meta-analysis

Sholeh

Krutova

Forouzesh

et al. 2020

Antimicrob Resist Infect Control

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“…2 and 3), the hGMB also includes considerable numbers of strains representing known species that were research hotspots in human GM studies. Some of these "star species" were commonly recognized to have probiotic potentials, such as Akkermansia muciniphila [65], Faecalibacterium prausnitzii [66], Roseburia intestinalis [67], Lactobacillus and Bi dobacterium members [68,69], while some others, as Enterococcus faecium [70], Ruminococcus gnavus [71], Clostridioides di cile (Peptoclostridium di cile) [72] and Klebsiella species [73], were revealed to play pathogenic role in hosts. There is a large group of gut microbial species that were reported to have strain-speci c effects on hosts [74,75].…”

Section: Discussionmentioning

confidence: 99%

Enlightening the Taxonomy Darkness of Human Gut Microbiomes With Cultured Biobank

Liu

Abuduaini

et al. 2020

Preprint

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Background The cultivated gut microbial resource plays essential role in gut microbiome studies such as gut microbial function and their interactions with host. Though several major studies had been performed to understand the cultured human gut microbiota, up to 70% of the Unified Human Gastrointestinal Genome species remain uncultivated and their taxonomy is not clear. Large-scale gut microbial isolation and identification and their access to pubic are imperative for gut microbial studies and for understanding of the human gut microbial functions.Results Here, we report the construction of an human Gut Microbial Biobank (hGMB) (homepage: hgmb.nmdc.cn) by large-scale cultivation of 10,558 isolates from 239 feces of healthy Chinese volunteers, and deposited 1,170 strains representing 404 different species in International Depository Authority for long-term preservation and public access worldwidely. We discovered and denominated 107 new species, and proposed 28 new genera and 3 new families. The new species and their newly sequenced genomes uncovered 16 “most-wanted” or “medium priority” taxa proposed by the Human Microbiome Project and 42 previously-uncultured MAGs in IGGdb, respectively. The hGMB represented over 80% of the common and dominant human gut microbial genera or species of global human gut 16S rRNA gene amplicon data (n=11,647), and covered 70% of the known genes (KEGG Orthologys) and 10% of the functionally-unknown genes in the global human gut gene catalogs. Conclusions A publically accessible human Gut Microbial Biobank (hGMB) that contains 1,170 strains and represents 404 human gut microbial speces is estabolished. The hGMB expands the currently known, taxonomically-characterized gut microbial resources and genomic repository by adding 107 new species and 115 new genomes of human gut microbes. Based on the newly discovered species in this study, 28 new genera and 3 new families of human gut microbes were identified and proposed.

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“…There is also potential for use of manuka honey as an adjunct therapy to standard regimens of metronidazole or vancomycin. While resistance to vancomycin remains low overall for C. difficile (<5%), there are indications that resistance is increasing [ 5 ]. Synergistic activity between manuka honey and vancomycin has been observed for eradicating Staphyloccoccus aureus biofilm in vitro [ 29 ], but such studies are few and none have not been done for CDI.…”

Section: Discussionmentioning

confidence: 99%

“…C. difficile infection (CDI) is difficult to eradicate despite antibiotic treatment, with a recurrence rate of 20–25%. Therapeutic failure is generally caused by the survival of organisms in the spore form, persistence in gastrointestinal mucosa biofilm, and host factors that increase vulnerability, rather than by antibiotic resistance [ 4 , 5 ]. Modulation of the host response to prevent CDI or recurrence such as through vaccination remains investigative at this time [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

The Bactericidal Activity and Spore Inhibition Effect of Manuka Honey against Clostridioides Difficile

Palafox-Rosas

Luna

et al. 2020

Antibiotics

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Clostridioides difficile colitis overgrowth occurs when the normal gut microbiome becomes disrupted, often due to antibiotics. Effective treatment remains elusive, due partly to the persistence of its spores in the gut. Natural substances like manuka honey offer an alternative antimicrobial mechanism of action to conventional antibiotics. We investigated the antibiotic activity of manuka honey against 20 C. difficile isolates. The minimum inhibitory concentrations (MICs) and minimal bactericidal concentrations (MBC) of manuka honeys of methylglyoxal (MGO) grades 30+, 100+, 250+, and 400+ were determined based on broth microdilution. Sporicidal activity was assessed in a range of honey concentrations by enumerating total viable cell and spore counts at 0–96 h after organism inoculation. The MICs of C. difficile ranged from 4% to >30% (w/v). MIC50 for the four MGO grades were similar at 10–14%. MBC results for the majority of isolates were distributed bimodally at MBC/MIC ratios ≤4 or MBC >30%. Growth kinetics in honey showed total viable cell counts remaining >105 colony-forming units (CFU)/mL at all time points, whereas spore counts remained within 1-log of baseline (102 CFU/mL) in honey but steadily increased in the drug-free control to >105 CFU/mL by 96 h. Manuka honey demonstrated variable inhibitory and bactericidal activity against C. difficile. MGO grade had no noticeable impact on overall MIC distributions or bactericidal activity. Although manuka honey could inhibit spore proliferation, it did not eradicate spores completely.

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Increasing antibiotic resistance in Clostridioides difficile: A systematic review and meta-analysis

Cited by 52 publications

References 79 publications

Antimicrobial resistance in Clostridioides (Clostridium) difficile derived from humans: a systematic review and meta-analysis

Antimicrobial resistance in Clostridioides (Clostridium) difficile derived from humans: a systematic review and meta-analysis

Enlightening the Taxonomy Darkness of Human Gut Microbiomes With Cultured Biobank

The Bactericidal Activity and Spore Inhibition Effect of Manuka Honey against Clostridioides Difficile

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