Dept. of Microbiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Dept. of Medical Microbiology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
Antimicrob Resist Infect Control. 2020 Sep 25;9(1):158. doi: 10.1186/s13756-020-00815-5.
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.
In order to summarize the data on antimicrobial resistance to C. difficile derived from humans, a systematic review and meta-analysis were performed.
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.
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%).
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.
艰难梭菌（梭状芽孢杆菌）是一种重要的医源性腹泻病原体，然而，在医院环境外艰难梭菌感染（CDI）的发生率增加已被报道。艰难梭菌对抗菌药物的耐药性不断增加，可能会增加 CDI 发生和/或传播的风险。治疗 CDI 的抗菌药物数量有限，这令人担忧。
为了总结从人类中获得的艰难梭菌对抗菌药物的耐药数据，进行了系统评价和荟萃分析。
我们在五个文献数据库（MEDLINE[PubMed]、Scopus、Embase、Cochrane 图书馆和 Web of Science）中检索了 1992 年至 2019 年期间专注于艰难梭菌抗菌药物敏感性检测的研究。使用随机效应模型计算每种抗菌药物的加权总耐药率（WPR）。
共纳入 111 项研究。甲硝唑和万古霉素的 WPR 分别为 1.0%（95%CI 0-3%）和 1%（95%CI 0-2%）（>2mg/L 折点）和 0%（95%CI 0%）（≥32μg/ml 折点）。利福平（rifampin）和替加环素（tigecycline）的 WPR 分别为 37.0%（95%CI 18-58%）和 1%（95%CI 0-3%）。其他抗菌药物的 WPR 如下：环丙沙星 95%（95%CI 85-100%）、莫西沙星 32%（95%CI 25-40%）、克林霉素 59%（95%CI 53-65%）、阿莫西林/克拉维酸 0%（0-0%）、哌拉西林/他唑巴坦 0%（0-0%）和头孢曲松 47%（95%CI 29-65%）。四环素的 WPR 为 20%（95%CI 14-27%），美罗培南的 WPR 为 0%（95%CI 0-1%）；仅在一个分离株中报告了对 fidaxomicin 的耐药性（0.08%）。
甲硝唑、万古霉素、 fidaxomicin、美罗培南和哌拉西林/他唑巴坦的耐药性罕见。在替代 CDI 药物治疗中，替加环素的耐药率低于利福平。对 CDI 发展有高风险的抗菌药物显示出高水平的耐药性，其中第二代氟喹诺酮类和克林霉素的耐药性最高；阿莫西林/克拉维酸几乎没有耐药性。在人类临床艰难梭菌分离株中，有五分之一存在四环素耐药性。
