Tags

Type your tag names separated by a space and hit enter

The ClosER study: results from a three-year pan-European longitudinal surveillance of antibiotic resistance among prevalent Clostridium difficile ribotypes, 2011-2014.
Clin Microbiol Infect. 2018 Jul; 24(7):724-731.CM

Abstract

OBJECTIVES

Until the introduction of fidaxomicin, antimicrobial treatment for Clostridium difficile infection (CDI) was limited to metronidazole and vancomycin. The changing epidemiology of CDI and the emergence of epidemic C. difficile PCR ribotype 027 necessitate continued surveillance to identify shifts in antibiotic susceptibility. ClosER, currently the largest pan-European epidemiological study of C. difficile ribotype distribution and antibiotic susceptibility, aimed to undertake antimicrobial resistance surveillance pre- and post-introduction of fidaxomicin.

METHODS

Between July 2011 and July 2014, 39 sites across 22 European countries submitted 2830 C. difficile isolates for ribotyping, toxin testing and susceptibility testing to metronidazole, vancomycin, fidaxomicin, rifampicin, moxifloxacin, clindamycin, imipenem, chloramphenicol and tigecycline.

RESULTS

Ribotypes 027, 014, 001, 078, 020, 002, 126, 015 and 005 were most frequently isolated, and emergent ribotypes 198 and 356 were identified in Hungary and Italy, respectively. All isolates were susceptible to fidaxomicin, with scarce resistance to metronidazole (0.2%, 6/2694), vancomycin (0.1%, 2/2694) and tigecycline (0%). Rifampicin, moxifloxacin and clindamycin resistance was evident in multiple ribotypes. Lack of ribotype diversity correlated with greater antimicrobial resistance. Epidemic ribotypes (027/001) were associated with multiple antimicrobial resistance, and ribotypes 017, 018 and 356 with high-level resistance. Additional factors may also influence local ribotype prevalence.

CONCLUSIONS

Fidaxomicin susceptibility was retained post-introduction, and resistance to metronidazole and vancomycin was rare. Continued surveillance is needed, with more accurate classification and clarification of ribotype subtypes to further understand their role in the spread of resistance. Other factors may also influence changes in prevalence of C. difficile ribotypes with reduced antibiotic susceptibility.

Authors+Show Affiliations

Department of Microbiology, Leeds Teaching Hospitals Trust, Leeds, UK; Healthcare Associated Infections Research Group, Section of Molecular Gastroenterology, Leeds Institute for Biomedical and Clinical Sciences, University of Leeds, Leeds, UK. Electronic address: jane.freeman4@nhs.net.Healthcare Associated Infections Research Group, Section of Molecular Gastroenterology, Leeds Institute for Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.Healthcare Associated Infections Research Group, Section of Molecular Gastroenterology, Leeds Institute for Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.Department of Microbiology, Leeds Teaching Hospitals Trust, Leeds, UK.Healthcare Associated Infections Research Group, Section of Molecular Gastroenterology, Leeds Institute for Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.Healthcare Associated Infections Research Group, Section of Molecular Gastroenterology, Leeds Institute for Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.Astellas Pharma, Inc., Chertsey, UK.Department of Microbiology, Leeds Teaching Hospitals Trust, Leeds, UK; Healthcare Associated Infections Research Group, Section of Molecular Gastroenterology, Leeds Institute for Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29066403

Citation

Freeman, J, et al. "The ClosER Study: Results From a Three-year pan-European Longitudinal Surveillance of Antibiotic Resistance Among Prevalent Clostridium Difficile Ribotypes, 2011-2014." Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases, vol. 24, no. 7, 2018, pp. 724-731.
Freeman J, Vernon J, Pilling S, et al. The ClosER study: results from a three-year pan-European longitudinal surveillance of antibiotic resistance among prevalent Clostridium difficile ribotypes, 2011-2014. Clin Microbiol Infect. 2018;24(7):724-731.
Freeman, J., Vernon, J., Pilling, S., Morris, K., Nicholson, S., Shearman, S., Longshaw, C., & Wilcox, M. H. (2018). The ClosER study: results from a three-year pan-European longitudinal surveillance of antibiotic resistance among prevalent Clostridium difficile ribotypes, 2011-2014. Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases, 24(7), 724-731. https://doi.org/10.1016/j.cmi.2017.10.008
Freeman J, et al. The ClosER Study: Results From a Three-year pan-European Longitudinal Surveillance of Antibiotic Resistance Among Prevalent Clostridium Difficile Ribotypes, 2011-2014. Clin Microbiol Infect. 2018;24(7):724-731. PubMed PMID: 29066403.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The ClosER study: results from a three-year pan-European longitudinal surveillance of antibiotic resistance among prevalent Clostridium difficile ribotypes, 2011-2014. AU - Freeman,J, AU - Vernon,J, AU - Pilling,S, AU - Morris,K, AU - Nicholson,S, AU - Shearman,S, AU - Longshaw,C, AU - Wilcox,M H, AU - ,, Y1 - 2017/10/21/ PY - 2017/07/18/received PY - 2017/09/29/revised PY - 2017/10/12/accepted PY - 2017/10/27/pubmed PY - 2018/11/28/medline PY - 2017/10/26/entrez KW - Antibiotic resistance KW - Clostridium difficile KW - Epidemiology KW - Prevalence KW - Ribotype SP - 724 EP - 731 JF - Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases JO - Clin. Microbiol. Infect. VL - 24 IS - 7 N2 - OBJECTIVES: Until the introduction of fidaxomicin, antimicrobial treatment for Clostridium difficile infection (CDI) was limited to metronidazole and vancomycin. The changing epidemiology of CDI and the emergence of epidemic C. difficile PCR ribotype 027 necessitate continued surveillance to identify shifts in antibiotic susceptibility. ClosER, currently the largest pan-European epidemiological study of C. difficile ribotype distribution and antibiotic susceptibility, aimed to undertake antimicrobial resistance surveillance pre- and post-introduction of fidaxomicin. METHODS: Between July 2011 and July 2014, 39 sites across 22 European countries submitted 2830 C. difficile isolates for ribotyping, toxin testing and susceptibility testing to metronidazole, vancomycin, fidaxomicin, rifampicin, moxifloxacin, clindamycin, imipenem, chloramphenicol and tigecycline. RESULTS: Ribotypes 027, 014, 001, 078, 020, 002, 126, 015 and 005 were most frequently isolated, and emergent ribotypes 198 and 356 were identified in Hungary and Italy, respectively. All isolates were susceptible to fidaxomicin, with scarce resistance to metronidazole (0.2%, 6/2694), vancomycin (0.1%, 2/2694) and tigecycline (0%). Rifampicin, moxifloxacin and clindamycin resistance was evident in multiple ribotypes. Lack of ribotype diversity correlated with greater antimicrobial resistance. Epidemic ribotypes (027/001) were associated with multiple antimicrobial resistance, and ribotypes 017, 018 and 356 with high-level resistance. Additional factors may also influence local ribotype prevalence. CONCLUSIONS: Fidaxomicin susceptibility was retained post-introduction, and resistance to metronidazole and vancomycin was rare. Continued surveillance is needed, with more accurate classification and clarification of ribotype subtypes to further understand their role in the spread of resistance. Other factors may also influence changes in prevalence of C. difficile ribotypes with reduced antibiotic susceptibility. SN - 1469-0691 UR - https://www.unboundmedicine.com/medline/citation/29066403/The_ClosER_study:_results_from_a_three_year_pan_European_longitudinal_surveillance_of_antibiotic_resistance_among_prevalent_Clostridium_difficile_ribotypes_2011_2014_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1198-743X(17)30570-0 DB - PRIME DP - Unbound Medicine ER -