Department of Microbiology, Leeds Teaching Hospitals Trust, Leeds, UK; Healthcare Associated Infections Research Group, Section of Molecular Gastroenterology, Leeds Institute for Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.
Healthcare Associated Infections Research Group, Section of Molecular Gastroenterology, Leeds Institute for Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.
Clin Microbiol Infect. 2018 Jul;24(7):724-731. doi: 10.1016/j.cmi.2017.10.008. Epub 2017 Oct 21.
Until the introduction of fidaxomicin, antimicrobial treatment for Clostridium difficile infection (CDI) was limited to metronidazole and vancomycin. The changing epidemiology of CDI and the emergence of epidemic C. difficile PCR ribotype 027 necessitate continued surveillance to identify shifts in antibiotic susceptibility. ClosER, currently the largest pan-European epidemiological study of C. difficile ribotype distribution and antibiotic susceptibility, aimed to undertake antimicrobial resistance surveillance pre- and post-introduction of fidaxomicin.
Between July 2011 and July 2014, 39 sites across 22 European countries submitted 2830 C. difficile isolates for ribotyping, toxin testing and susceptibility testing to metronidazole, vancomycin, fidaxomicin, rifampicin, moxifloxacin, clindamycin, imipenem, chloramphenicol and tigecycline.
Ribotypes 027, 014, 001, 078, 020, 002, 126, 015 and 005 were most frequently isolated, and emergent ribotypes 198 and 356 were identified in Hungary and Italy, respectively. All isolates were susceptible to fidaxomicin, with scarce resistance to metronidazole (0.2%, 6/2694), vancomycin (0.1%, 2/2694) and tigecycline (0%). Rifampicin, moxifloxacin and clindamycin resistance was evident in multiple ribotypes. Lack of ribotype diversity correlated with greater antimicrobial resistance. Epidemic ribotypes (027/001) were associated with multiple antimicrobial resistance, and ribotypes 017, 018 and 356 with high-level resistance. Additional factors may also influence local ribotype prevalence.
Fidaxomicin susceptibility was retained post-introduction, and resistance to metronidazole and vancomycin was rare. Continued surveillance is needed, with more accurate classification and clarification of ribotype subtypes to further understand their role in the spread of resistance. Other factors may also influence changes in prevalence of C. difficile ribotypes with reduced antibiotic susceptibility.
在 fidaxomicin 问世之前，治疗艰难梭菌感染（CDI）的抗菌药物治疗仅限于甲硝唑和万古霉素。CDI 的流行病学不断变化，以及流行的 C. difficile PCR 核糖型 027 的出现，需要持续监测以确定抗生素敏感性的变化。ClosER 是目前针对艰难梭菌核糖型分布和抗生素敏感性的最大泛欧流行病学研究，旨在在 fidaxomicin 问世之前和之后进行抗生素耐药性监测。
在 2011 年 7 月至 2014 年 7 月期间，来自 22 个欧洲国家的 39 个地点提交了 2830 株艰难梭菌分离株进行核糖型分型、毒素检测和对甲硝唑、万古霉素、 fidaxomicin、利福平、莫西沙星、克林霉素、亚胺培南、氯霉素和替加环素的药敏试验。
027、014、001、078、020、002、126、015 和 005 核糖型最常被分离，匈牙利和意大利分别发现了新兴的 198 和 356 核糖型。所有分离株均对 fidaxomicin 敏感，对甲硝唑（0.2%，6/2694）、万古霉素（0.1%，2/2694）和替加环素（0%）的耐药性很少。利福平、莫西沙星和克林霉素耐药性在多个核糖型中均有表现。缺乏核糖型多样性与更高的抗生素耐药性相关。流行核糖型（027/001）与多种抗生素耐药性相关，而核糖型 017、018 和 356 与高水平耐药性相关。其他因素也可能影响当地核糖型的流行率。
fidaxomicin 引入后仍保持敏感性，甲硝唑和万古霉素耐药性罕见。需要继续进行监测，并对核糖型进行更准确的分类和澄清，以进一步了解它们在耐药性传播中的作用。其他因素也可能影响具有较低抗生素敏感性的艰难梭菌核糖型的流行率变化。
