Maraki Sofia, Mavromanolaki Viktoria Eirini, Stafylaki Dimitra, Iliaki-Giannakoudaki Evangelia, Kasimati Anna
Med Princ Pract. 2024 Mar 20;33(4):392-8. doi: 10.1159/000538414.
Clostridioides difficile is a major cause of healthcare-associated diarrhea worldwide. For years, metronidazole and vancomycin were considered the standard treatment for C. difficile infection (CDI). However, they are increasingly being associated with treatment failure and recurrence. In this study we investigated the in vitro activity of dalbavancin and fourteen other antimicrobials against 155 toxigenic C. difficile isolates originating from patients with C. difficile-associated diarrhea.
Antimicrobial susceptibility was evaluated by the MIC Test Strip and the results were interpreted using both the Clinical and Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial susceptibility Testing (EUCAST) breakpoints.
C. difficile isolates were fully susceptible to metronidazole, vancomycin, amoxicillin/ clavulanate, piperacillin/tazobactam, and tigecycline. All isolates were dalbavancin susceptible by the CLSI breakpoint (≤ 0.25 μg/ml) compared with 97.4% susceptibility by the EUCAST breakpoint (≤ 0.125 μg/ml). Dalbavancin demonstrated significantly lower MIC50 and MIC90 values compared to vancomycin (0.047 vs. 0.38 and 0.125 vs. 0.5, respectively, p < 0.001). Resistance rates to penicillin, ampicilin, cefoxitin, imipenem, meropenem, clindamycin, moxifloxacin, chloramphenicol, and tetracycline were 20%, 14.2% , 100%, 75.5%, 0.6%, 51%, 36.1%, 3.2%, and 14.8%, respectively. Multidrug-resistant (MDR) phenotypes were detected among 41.3% of the isolates.
Dalbavancin exhibited potent activity against the isolates tested. As C. difficile is an important healthcare-associated pathogen, continued surveillance is required to monitor for development of resistance.
艰难梭菌是全球医疗保健相关腹泻的主要病因。多年来，甲硝唑和万古霉素一直被视为艰难梭菌感染（CDI）的标准治疗药物。然而，它们与治疗失败和复发的关联日益增加。在本研究中，我们调查了达巴万星和其他十四种抗菌药物对155株源自艰难梭菌相关性腹泻患者的产毒艰难梭菌分离株的体外活性。
采用MIC测试条评估抗菌药物敏感性，并使用临床和实验室标准协会（CLSI）及欧洲抗菌药物敏感性测试委员会（EUCAST）的断点解释结果。
艰难梭菌分离株对甲硝唑、万古霉素、阿莫西林/克拉维酸、哌拉西林/他唑巴坦和替加环素完全敏感。根据CLSI断点（≤0.25μg/ml），所有分离株对达巴万星敏感，而根据EUCAST断点（≤0.125μg/ml），敏感性为97.4%。与万古霉素相比，达巴万星的MIC50和MIC90值显著更低（分别为0.047对0.38以及0.125对0.5，p<0.001）。对青霉素、氨苄西林、头孢西丁、亚胺培南、美罗培南、克林霉素、莫西沙星、氯霉素和四环素的耐药率分别为20%、14.2%、100%、75.5%、0.6%、51%、36.1%、3.2%和14.8%。41.3%的分离株检测到多重耐药（MDR）表型。
达巴万星对测试的分离株表现出强大的活性。由于艰难梭菌是一种重要的医疗保健相关病原体，需要持续监测以监测耐药性的发展。
