Update on Antimicrobial Resistance in Clostridium difficile: Resistance Mechanisms and Antimicrobial Susceptibility Testing

Abstract

Oral antibiotics such as metronidazole, vancomycin and fidaxomicin are therapies of choice for infection. Several important mechanisms for antibiotic resistance have been described, including the acquisition of antibiotic resistance genes via the transfer of mobile genetic elements, selective pressure resulting in gene mutations, altered expression of redox-active proteins, iron metabolism, and DNA repair, as well as via biofilm formation. This update summarizes new information published since 2010 on phenotypic and genotypic resistance mechanisms in and addresses susceptibility test methods and other strategies to counter antibiotic resistance of .

Retracted: Prevalence, antibiotic resistance, and toxigenic gene profile of the Clostridium difficile isolated from molluscan shellfish

“…Metronidazol and vancomycin are the most commonly used antibiotic agents to treat C. difficile associated diarrhea. However, our research demonstrates that there is resistance of C. difficile strains against metronidazol (57.69%) and vancomycin (37.46%) which was similar to previously published works (Chow et al, ; Norman et al, ; Peng et al, ; Thitaram et al, ; Troiano et al, ). In keeping with the high prevalence of C. difficile in marine foods, presence of other pathogenic foodborne agents has been reported in different types of food samples previously (Atapoor, Dehkordi, & Rahimi, ; Ghorbani, Gheisari, & Dehkordi, ; Hemmatinezhad et al, ; Madahi, Rostami, Rahimi, & Dehkordi, ; Momtaz, Davood Rahimian, & Safarpoor Dehkordi, ; Momtaz, Dehkordi, Rahimi, Asgarifar, & Momeni, ; Momtaz, Safarpoor Dehkordi, Taktaz, Rezvani, & Yarali, ; Rahimi, Yazdanpour, & Dehkordi, ; Rahimi et al, ; Ranjbar, Masoudimanesh, Dehkordi, Jonaidi‐Jafari, & Rahimi, ; Safarpoor Dehkordi, Barati, Momtaz, Hosseini Ahari, & Nejat Dehkordi, ; Safarpoor Dehkordi, Gandomi, Akhondzadeh Basti, Misaghi, & Rahimi, ; Safarpoor Dehkordi, Haghighi, Momtaz, Rafsanjani, & Momeni, ; Safarpoor Dehkordi, Khamesipour, & Momeni, ; Safarpoor Dehkordi et al, ; Safarpoor Dehkordi, Valizadeh, Birgani, & Dehkordi, ).…”

“…Antibiotic resistance is another important aspect of the pathogenesis of CDI. Clostridium difficile strains recovered from food and cases of intestinal infections harbored the high prevalence of resistance against commonly used groups of antibiotics including penicillins, quinolones, carbapenems, macrolides, aminoglycosides, cephalosporins, fluoroquinolones, sulfonamides, and tetracycline (Peng et al, 2017).…”

The role of vaccines in fighting antimicrobial resistance (AMR)

“…6 Additionally, given our global connectivity, antibiotic resistance can rapidly spread worldwide. A more recent example is metronidazole resistance in Clostridium difficile that developed quickly and led to a rapid spread of a quinolone resistant epidemic strains across the globe (Figure 1), 7 causing high morbidity and mortality. 8 Likewise genomic analysis of S. aureus clinical isolates has been able to map the development of fluoroquinolone resistance to the timeframe and region where the first fluoroquinolone clinical trials were conducted.…”

Genome Characterization of a Novel Binary Toxin-Positive Strain of <em>Clostridium difficile</em> and Comparison with the Epidemic 027 and 078 Strains

“…It has been proposed that the use of antibiotics is the most important risk factor for CDI [4], because C. difficile is resistant to multiple antibiotics that are commonly used for treating bacterial infections in clinical settings [2,43]. Therefore, so many antibiotic resistancerelated genes harbored in the ST201 strains may contribute to the bacterial pathogenesis.…”