Metronidazole Resistance in Clostridium difficile

Sanchez, Jason L.; Gerding, Dale N.

doi:10.1086/313955

Cited by 39 publications

(22 citation statements)

References 5 publications

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“…One concern with repeated use of metronidazole for recurrent CDAD cases is the development of antibiotic resistance (Johnson et al, 2000). A study from Spain documented metronidazole resistance in 6 .…”

Section: Metronidazolementioning

confidence: 99%

Alternative treatments for Clostridium difficile disease: what really works?

McFarland

2005

Journal of Medical Microbiology

141

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Vancomycin and metronidazole have been used for treating Clostridium difficile-associated disease (CDAD) for the past 25 years, but approximately 20 % of patients develop recurrent disease. The increasing incidence of nosocomial outbreaks, cases of recurrent CDAD and other complications (toxic megacolon, ileus, sepsis) has fuelled the search for different types of treatments. As the understanding of the pathogenesis of this disease has matured, newer treatment strategies that take advantage of these mechanisms have been developed. This review will describe such treatments and examine the evidence for each strategy.

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Section: Metronidazolementioning

confidence: 99%

Alternative treatments for Clostridium difficile disease: what really works?

McFarland

2005

Journal of Medical Microbiology

141

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“…Several studies indicate that the MICs of vancomycin and metronidazole for C. difficile have remained low over the years (5,8,10,12).…”

Section: Vancomycinmentioning

confidence: 99%

“…As several studies have reported full susceptibility of C. difficile isolates for metronidazole and vancomycin, clinical laboratories do not routinely perform culture and susceptibility testing of the organism (5,8,10,12). However, resistance to metronidazole in up to 9% of isolates (1,4,6,18), intermediate resistance to vancomycin in 3% of isolates (1), and "relatively poor" outcome of metronidazole therapy in CDAD (15,19,28) was recently reported.…”

mentioning

confidence: 99%

Antimicrobial Susceptibility Pattern of Clostridium difficile and Its Relation to PCR Ribotypes in a Swedish University Hospital

Aspevall

Lundberg

Burman

et al. 2006

Antimicrob Agents Chemother

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All 238 Clostridium difficile isolates were susceptible to metronidazole and vancomycin, whereas 84% and 1% were resistant to clindamycin and fusidic acid. Etest MICs for metronidazole were lower than agar dilution MICs (P < 0.01) but without difference in susceptible-intermediate-resistant categorization. No particular PCR ribotype was associated with clindamycin or fusidic acid resistance.Clostridium difficile-associated diarrhea (CDAD) is common in hospitals (2,3,11,14,21,22,27,29) and usually treated with metronidazole or vancomycin, which have comparable response rates (80% to 90%) and relapse rates (5% to 25%) (13,23). Metronidazole is currently the first choice agent due to its lower potential for selecting vancomycin-resistant enterococci and for economical reasons, and fusidic acid has been suggested as an alternative drug (17, 30).As several studies have reported full susceptibility of C. difficile isolates for metronidazole and vancomycin, clinical laboratories do not routinely perform culture and susceptibility testing of the organism (5,8,10,12). However, resistance to metronidazole in up to 9% of isolates (1,4,6,18), intermediate resistance to vancomycin in 3% of isolates (1), and "relatively poor" outcome of metronidazole therapy in CDAD (15,19,28) was recently reported. This emphasizes the need for periodic monitoring of any emergence of drug resistance in C. difficile. The aim of the present study was to investigate its susceptibility to metronidazole, vancomycin, fusidic acid, and clindamycin in a Swedish tertiary care hospital by using the Etest.The first C. difficile isolate from each of 238 consecutive CDAD patients at Huddinge University Hospital, Stockholm, Sweden, from 10 February 2000 through 10 February 2001, were studied. The definition of CDAD, culture method, and epidemiological data for these patients were recently described (25). All C. difficile isolates were also subject to PCR ribotyping according to the method of Stubbs et al. (24) but with an improved method previously correlated with serotypes (25). Isolates were subcultured three times on horse blood agar prior to susceptibility testing to ensure purity. Bacteria were suspended in tryptic soy broth to a McFarland standard of 1 to 1.5 for testing against clindamycin, fusidic acid, metronidazole, and vancomycin by Etest on Brucella blood agar according to the manufacturer's instructions (AB-Biodisk, Solna, Sweden). Plates were scored after anaerobic incubation at 36°C for 48 h.A random subset of 34 isolates was also tested using agar dilution to determine metronidazole MICs for comparison with Etest data. Agar dilution was performed on Wilkins-Chalgren agar (1) incubated as described above. Eubacterium lentum ATCC 43055 and Clostridium perfringens ATCC 13124 were used for quality control.MICs for the drugs tested are shown in Table 1. Using the pharmacological breakpoints (Table 1) recommended by the Swedish Reference Group for Antibiotics (SRGA) (http://www .srga.org), all isolates were susceptible to metronidazole and vancom...

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“…23 Antibiotic resistance does not play a major role. 61 Risk factors for relapse include previous relapse, sicker patients (leukocytosis, chronic renal failure), recent abdominal surgery, and possibly colonic diverticula. 59,60 After treatment for recurrence, 20%-65% will relapse again.…”

Section: T R E a T M E N T O F R E C U R R E N T I N F E C T I O Nmentioning

confidence: 99%