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Antibiotic-associated colitis: effects of antibiotics on Clostridium difficile and the disease in hamsters
Abstract:
Fifteen isolates of Clostridium difficile from hamsters and human patients were inhibited or killed by low concentrations of metronidazole, vancomycin, penicillin, and ampicillin; the isolates were often reesistant to tetracycline, cephalosporins, trimethoprim-sulfamethoxazole, clindamycin, erythromycin, and aminoglycosides. Antibiotics to which C. difficile was susceptible were able to prevent or postpone the colitis caused by clindamycin in hamsters. Colitis could be produced by treatment of hamsters with any one of these antibiotics. Production of colitis not only involved selection of resistant variants, but in some instances seemed to result from the acquisition of organisms after treatment, their persistence despite treatment, or from subinhibitory cecal concentrations of antibiotic (explainable by either pharmacologic factors or enzymatic inactivation). As in humans, no organisms other than C. difficile have been implicated conclusively as etiologic agents of colitis in hamsters. Our results suggest it may be wise to use isolation precautions for patients with colitis caused by C. difficile.
Insights
Clostridium difficile (C. difficile) isolates showed resistance to many antibiotics but susceptibility to others. Susceptible antibiotics prevented or delayed C. difficile-induced colitis in hamsters, suggesting isolation precautions for patients.
Area of Science:
- Microbiology
- Infectious Diseases
- Pharmacology
Background:
- Clostridium difficile is a significant cause of infectious diarrhea.
- Antibiotic use is a major risk factor for C. difficile-associated colitis.
- Understanding antibiotic susceptibility is crucial for managing C. difficile infections.
Purpose of the Study:
- To investigate the antibiotic susceptibility patterns of Clostridium difficile isolates.
- To explore the role of antibiotics in the development of C. difficile-induced colitis in a hamster model.
- To evaluate the efficacy of susceptible antibiotics in preventing or delaying colitis.
Main Methods:
- Antibiotic susceptibility testing of 15 Clostridium difficile isolates from hamsters and humans.
- Induction of colitis in hamsters using various antibiotics.
- Observation of colitis development and prevention/delay by susceptible antibiotics.
Main Results:
- Isolates were susceptible to metronidazole, vancomycin, penicillin, and ampicillin.
- Resistance was common to tetracycline, cephalosporins, clindamycin, erythromycin, and aminoglycosides.
- Antibiotics to which C. difficile was susceptible prevented or postponed colitis; other antibiotics could induce colitis.
Conclusions:
- Antibiotic selection pressure can lead to C. difficile colitis through resistant variants or altered gut environments.
- Clindamycin-induced colitis in hamsters serves as a relevant model for human disease.
- Isolation precautions are recommended for patients with C. difficile colitis.