2018
DOI: 10.1016/j.cmi.2017.10.008
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The ClosER study: results from a three-year pan-European longitudinal surveillance of antibiotic resistance among prevalent Clostridium difficile ribotypes, 2011–2014

Abstract: 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.

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Cited by 106 publications
(92 citation statements)
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“…There were no differences in fidaxomicin MIC 50 and MIC 90 values over the three time intervals. Studies from other countries have shown similar results; over 2,500 isolates obtained from patients between 2011 and 2014 across 22 European countries remained highly susceptible to fidaxomicin (10). This was also true in surveillance studies undertaken in Canada from 2013 to 2015 (11) and Australia from 2013 to 2015 (12).…”
Section: Discussionmentioning
confidence: 59%
“…There were no differences in fidaxomicin MIC 50 and MIC 90 values over the three time intervals. Studies from other countries have shown similar results; over 2,500 isolates obtained from patients between 2011 and 2014 across 22 European countries remained highly susceptible to fidaxomicin (10). This was also true in surveillance studies undertaken in Canada from 2013 to 2015 (11) and Australia from 2013 to 2015 (12).…”
Section: Discussionmentioning
confidence: 59%
“…46 The presence of an antimicrobial resistance gene does not always result in resistance, and DNA-based identification of putative resistance genes without phenotypic confirmation may lead to an overestimation of the resistance frequencies. 14, 47, 48…”
Section: Discussionmentioning
confidence: 99%
“…Routine antimicrobial susceptibility testing is generally not performed for C. difficile and consequently, reports of resistance to metronidazole are rare. 1315 Longitudinal surveillance in Europe found that 0·2% of clinical isolates investigated were resistant to metronidazole, 14 but reported rates from other studies vary from 0-18·3%. 1619 These differences may reflect geographic distributions in resistant strains, or differences in testing methodology and breakpoints used.…”
Section: Introductionmentioning
confidence: 99%
“…However, there is a need for scientific evidence explaining the decline in metronidazole efficacy, as continued use of the drug is likely until the new guidelines become standard practice. The decline in metronidazole efficacy appears to correlate with the emergence and spread of resistant strains of different ribotype backgrounds (6-8); metronidazole resistance is defined by the EUCAST breakpoint of >2 μg/ml. For example, Snydman reported that ∼8% of U.S. isolates (2011-2016) are resistant to metronidazole (7), while the rate in Europe ranged from 0.1% to 0.5% for isolates collected between 2011 to 2014 (6).…”
Section: Introductionmentioning
confidence: 99%