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Antimicrobial Resistance of Clostridioides difficile in Children from a Tertiary Pediatric Hospital in Shanghai,

Xiaolu Li1, Yizhong Wang1,2, Rong Cao1

  • 1Department of Gastroenterology, Hepatology and Nutrition, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China.

Infection and Drug Resistance
|January 31, 2024
PubMed

Insights

Emerging resistance to metronidazole and vancomycin in pediatric Clostridioides difficile infection (CDI) is a growing concern in China. Further research is needed to understand the novel resistance mechanisms in C. difficile isolates.

Area of Science:

  • Microbiology
  • Infectious Diseases
  • Pediatrics

Background:

  • Previous studies indicated a high recurrence rate of Clostridioides difficile infection (CDI) in children post-antibiotic therapy.
  • Investigating the prevalence of metronidazole and vancomycin resistant C. difficile isolates in pediatric CDI cases is crucial.

Purpose of the Study:

  • To determine the presence and characteristics of metronidazole and vancomycin resistant C. difficile isolates in pediatric CDI patients.
  • To identify antibiotic resistance genes (ARGs) and specific resistance mechanisms in these isolates.

Main Methods:

  • Antimicrobial susceptibility testing (AST) using agar dilution method for 50 C. difficile isolates from pediatric CDI patients (2019-2022).
  • Whole-genome sequencing (WGS) to identify ARGs using Resfinder and CARD databases.
  • Detection of pCD-METRO plasmid and vanA/B genes using SRST2.

Main Results:

  • High rates of resistance observed: 30% for metronidazole, 6% for vancomycin, and 88% multidrug-resistant (MDR) isolates.
  • Identified ARGs associated with resistance to aminoglycosides, lincosamides, fluoroquinolones, glycopeptides, tetracyclines, and trimethoprim.
  • Absence of pCD-METRO plasmid and vanA/B genes in all tested isolates.

Conclusions:

  • C. difficile isolates with reduced susceptibility to metronidazole and vancomycin are emerging in pediatric CDI in China.
  • The lack of common resistance markers (pCD-METRO, vanA/B) suggests novel resistance mechanisms are involved.
  • This finding highlights the need for continued surveillance and research into pediatric CDI resistance patterns.
Abstract

Keywords:
Clostridioides difficileantibiotic resistancechildrenmetronidazolevancomycin

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