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Sequence-Based Identification of Metronidazole-Resistant Clostridioides difficile Isolates

Wiep Klaas Smits, Céline Harmanus, Ingrid M J G Sanders

    Emerging Infectious Diseases
    |October 26, 2022
    PubMed

    Insights

    The pCD-METRO plasmid causes metronidazole resistance in Clostridioides difficile. This plasmid is widespread in clinical and veterinary settings in the Americas, necessitating detection via PCR or genomic assays.

    Area of Science:

    • Microbiology
    • Genetics
    • Infectious Diseases

    Background:

    • Clostridioides difficile is an opportunistic pathogen causing significant healthcare-associated infections.
    • Metronidazole is a key antibiotic for treating C. difficile infections.
    • Emergence of antibiotic resistance in C. difficile poses a therapeutic challenge.

    Purpose of the Study:

    • To characterize the pCD-METRO plasmid responsible for metronidazole resistance in C. difficile.
    • To investigate the prevalence and distribution of pCD-METRO in clinical and veterinary isolates.
    • To recommend diagnostic strategies for identifying metronidazole-resistant C. difficile.

    Main Methods:

    • Plasmid sequencing and comparative analysis.
    • Isolate screening from clinical and veterinary sources.
    • Development and validation of molecular detection methods (PCR, genomic assays).

    Main Results:

    • High sequence similarity was observed among pCD-METRO plasmids from diverse isolates.
    • The pCD-METRO plasmid and associated resistant C. difficile strains were identified in reservoirs across the Americas.
    • The presence of pCD-METRO correlates with metronidazole resistance.

    Conclusions:

    • The pCD-METRO plasmid is a significant driver of metronidazole resistance in C. difficile.
    • Widespread dissemination of pCD-METRO in both human and animal populations necessitates surveillance.
    • Molecular detection methods like PCR are recommended for timely identification of resistant strains.
    Keywords:
    Antimicrobial resistanceBrazilClostridioides difficileSouth AmericaUnited Statesbacteriaenteric infectionsmetronidazolepCD-METROplasmidsequence analysisthe Netherlands

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