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A Protocol to Characterize the Morphological Changes of Clostridium difficile in Response to Antibiotic Treatment
Published on: May 25, 2017
Antimicrobial resistance in Clostridium difficile ribotype 017
Korakrit Imwattana1,2, Daniel R Knight3, Brian Kullin4
1School of Biomedical Sciences, The University of Western Australia, Crawley, Australia.
Abstract:
Introduction: Antimicrobial resistance (AMR) played an important role in the initial outbreaks of Clostridium difficile infection (CDI) in the 1970s. C. difficile ribotype (RT) 017 has emerged as the major strain of C. difficile in Asia, where antimicrobial use is poorly regulated. This strain has also caused CDI outbreaks around the world for almost 30 years. Many of these outbreaks were associated with clindamycin and fluoroquinolone resistance. AMR and selective pressure is likely to be responsible for the success of this RT and may drive future outbreaks.Areas covered: This narrative review summarizes the prevalence and mechanisms of AMR in C. difficile RT 017 and transmission of these AMR mechanisms. To address these topics, reports of outbreaks due to C. difficile RT 017, epidemiologic studies with antimicrobial susceptibility results, studies on resistance mechanisms found in C. difficile and related publications available through Pubmed until September 2019 were collated and the findings discussed.Expert opinion: Primary prevention is the key to control CDI. This should be achieved by developing antimicrobial stewardship in medical, veterinary and agricultural practices. AMR is the key factor that drives CDI outbreaks, and methods for the early detection of AMR can facilitate the control of outbreaks.
Insights
Antimicrobial resistance (AMR) drives Clostridium difficile infection (CDI) outbreaks, particularly with the prevalent C. difficile RT 017 strain. Controlling CDI requires antimicrobial stewardship and early detection of AMR.
Area of Science:
- Microbiology
- Infectious Diseases
- Epidemiology
Background:
- Antimicrobial resistance (AMR) has been linked to Clostridium difficile infection (CDI) outbreaks since the 1970s.
- Clostridium difficile ribotype (RT) 017 is a significant global strain, prevalent in Asia due to unregulated antimicrobial use.
- This strain is associated with clindamycin and fluoroquinolone resistance, driving CDI outbreaks worldwide.
Purpose of the Study:
- To review the prevalence and mechanisms of AMR in C. difficile RT 017.
- To examine the transmission of AMR mechanisms within C. difficile.
- To discuss the role of AMR in driving CDI outbreaks.
Main Methods:
- A narrative review of publications on C. difficile RT 017 outbreaks and AMR.
- Inclusion of epidemiologic studies with antimicrobial susceptibility data.
- Analysis of studies on C. difficile resistance mechanisms up to September 2019.
Main Results:
- C. difficile RT 017 exhibits significant AMR, particularly to clindamycin and fluoroquinolones.
- AMR and selective pressure are key factors in the success and spread of this strain.
- Outbreaks of CDI are strongly associated with AMR in C. difficile strains.
Conclusions:
- Primary prevention through antimicrobial stewardship in medical, veterinary, and agricultural practices is crucial for CDI control.
- AMR is a primary driver of CDI outbreaks.
- Early detection of AMR facilitates effective outbreak control strategies.
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