Barkin Jodie A, Sussman Daniel A, Fifadara Nimita, Barkin Jamie S
Division of Gastroenterology, Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, 1120 NW 14th Street, Clinical Research Building, Suite 1116, Miami, FL, 33136, USA.
DRG Laboratory, 2001 Westside Parkway, Suite 240, Alpharetta, GA, 30004, USA.
Dig Dis Sci. 2017 Apr;62(4):1035-1042. doi: 10.1007/s10620-017-4462-9. Epub 2017 Jan 23.
Clostridium difficile (CD) infection (CDI) causes marked morbidity and mortality, accounting for large healthcare expenditures annually. Current CDI treatment guidelines focus on clinical markers of patient severity to determine the preferred antibiotic regimen of metronidazole versus vancomycin. The antimicrobial resistance patterns for patients with CD are currently unknown.
The aim of this study was to define the antimicrobial resistance patterns for CD.
This study included all patients with stools sent for CD testing to a private laboratory (DRG Laboratory, Alpharetta, Georgia) in a 6-month period from across the USA. Patient data was de-identified, with only age, gender, and zip-code available per laboratory protocol. All samples underwent PCR testing followed by hybridization for CD toxin regions A and B. Only patients with CD-positive PCR were analyzed. Antimicrobial resistance testing using stool genomic DNA evaluated presence of imidazole- and vancomycin-resistant genes using multiplex PCR gene detection.
Of 2743, 288 (10.5%) stool samples were positive for CD. Six were excluded per protocol. Of 282, 193 (69.4%) were women, and average age was 49.4 ± 18.7 years. Of 282, 62 were PCR positive for toxins A and B, 160 for toxin A positive alone, and 60 for toxin B positive alone. Antimicrobial resistance testing revealed 134/282 (47.5%) patients resistant to imidazole, 17 (6.1%) resistant to vancomycin, and 9 (3.2%) resistant to imidazole and vancomycin.
CD-positive patients with presence of imidazole-resistant genes from stool DNA extract was a common phenomenon, while vancomycin resistance was uncommon. Similar to treatment of other infections, antimicrobial resistance testing should play a role in CDI clinical decision-making algorithms to enable more expedited and cost-effective delivery of patient care.
艰难梭菌（CD）感染（CDI）会导致显著的发病率和死亡率，每年造成大量医疗支出。当前的CDI治疗指南侧重于根据患者严重程度的临床指标来确定首选抗生素方案是甲硝唑还是万古霉素。目前尚不清楚CD患者的抗菌药物耐药模式。
本研究的目的是确定CD的抗菌药物耐药模式。
本研究纳入了在6个月内从美国各地送往一家私人实验室（佐治亚州阿尔法利塔的DRG实验室）进行CD检测的所有粪便样本患者。根据实验室规程，患者数据进行了去识别处理，仅提供年龄、性别和邮政编码。所有样本均进行了PCR检测，随后对CD毒素A和B区域进行杂交。仅对PCR检测为CD阳性的患者进行分析。使用粪便基因组DNA进行抗菌药物耐药性检测，通过多重PCR基因检测评估咪唑和万古霉素耐药基因的存在情况。
在2743份粪便样本中，288份（10.5%）CD检测呈阳性。根据规程排除了6份样本。在282份样本中，193份（69.4%）为女性，平均年龄为49.4±18.7岁。在282份样本中，62份毒素A和B的PCR检测呈阳性，160份仅毒素A呈阳性，60份仅毒素B呈阳性。抗菌药物耐药性检测显示，134/282（47.5%）的患者对咪唑耐药，17份（6.1%）对万古霉素耐药，9份（3.2%）对咪唑和万古霉素均耐药。
粪便DNA提取物中存在咪唑耐药基因的CD阳性患者是一种常见现象，而万古霉素耐药则不常见。与其他感染的治疗类似，抗菌药物耐药性检测应在CDI临床决策算法中发挥作用，以便更快速、经济高效地为患者提供护理。
