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Update on Antimicrobial Resistance in Clostridium difficile: Resistance Mechanisms and Antimicrobial Susceptibility
Zhong Peng1,2, Dazhi Jin3,4, Hyeun Bum Kim5
1Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
Abstract:
Oral antibiotics such as metronidazole, vancomycin and fidaxomicin are therapies of choice for Clostridium difficile infection. Several important mechanisms for C. difficile antibiotic resistance have been described, including the acquisition of antibiotic resistance genes via the transfer of mobile genetic elements, selective pressure in vivo 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 C. difficile and addresses susceptibility test methods and other strategies to counter antibiotic resistance of C. difficile.
Insights
Clostridium difficile antibiotic resistance is increasing due to gene mutations and biofilm formation. New strategies and susceptibility testing methods are crucial for combating C. difficile infections.
Area of Science:
- Microbiology
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Clostridium difficile infection (CDI) is a significant healthcare challenge.
- Oral antibiotics like metronidazole, vancomycin, and fidaxomicin are primary treatments for CDI.
- Understanding C. difficile antibiotic resistance mechanisms is vital for effective treatment.
Purpose of the Study:
- To review recent advances (since 2010) in C. difficile phenotypic and genotypic resistance mechanisms.
- To discuss susceptibility testing methods for C. difficile.
- To explore strategies for overcoming C. difficile antibiotic resistance.
Main Methods:
- Literature review of studies published since 2010.
- Analysis of documented C. difficile resistance mechanisms.
- Evaluation of current and emerging susceptibility testing methodologies.
Main Results:
- Key resistance mechanisms include mobile genetic element transfer, in vivo gene mutations, altered protein expression, and biofilm formation.
- Recent research has elucidated novel genotypic and phenotypic resistance pathways.
- Susceptibility testing methods are evolving to better detect resistance.
Conclusions:
- Continued research into C. difficile resistance is essential.
- Updated susceptibility testing and novel therapeutic strategies are needed.
- Combating CDI requires a multifaceted approach addressing resistance.