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Antibiotic resistance of clinical isolates of Clostridioides difficile in China and its association with geographical regions and patient age.
Anaerobe. 2019 Dec; 60:102094.A

Abstract

It is known that antibiotic usage is associated with the development of Clostridioides difficile infection (CDI), especially clindamycin, third-generation cephalosporins, and fuoroquinolones. Antibiotic resistance rates to many antibiotics varies a lot by study. We performed a study focused on antibiotic resistance in clinical isolates of C. difficile from more widespread geographic regions across China. Of 319 C. difficile isolates tested against 11 antibiotics, 313 (98.1%) were resistant to at least one antibiotic. The highest rate of resistance was to ciprofloxacin, clindamycin, and erythromycin across all age groups, similar to previous studies. However, all isolates were susceptible to metronidazole and vancomycin. Overall the resistance rate to tested antibiotics was lower than other reports in China except for chloramphenicol and meropenem. Genotype ST37/RT017 in clade 4 was resistant to more antibiotics than other types. Unexpectedly, RT078 isolates in this study were susceptible to almost all tested antibiotics. In addition, the proportion of multi-drug resistant (MDR) isolates observed (17%) in this study was much lower than several European studies (up to 55%) and a previous study in China (78%). Although isolates from patients aged between 65 and 85 were more resistant to antibiotics in comparison to other age groups, MDR isolates were still detected in children below 2-years of age. The highest percentage of MDR isolates was determined in South China, an area that is most developed economically. The clade 4, RT017 (ST37) has been associated with outbreaks in Europe and North America and is responsible for most C. difficile infections (CDIs) in Asia. In addition, RT017 is often clindamycin and fluoroquinolone resistant. This study provided a relatively comprehensive description of antibiotic resistance of C. difficile in China, and further elucidates the epidemiology and antibiotic resistance of clinical isolates of C. difficile in China at a national level.

Authors+Show Affiliations

State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Prevention and Control, Beijing, China; Regional Center for Disease Prevention and Control, Aksu, Xinjiang, China.State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Prevention and Control, Beijing, China.State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Prevention and Control, Beijing, China.Division of Infectious Diseases, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Prevention and Control, Beijing, China.State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Prevention and Control, Beijing, China.State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Prevention and Control, Beijing, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China. Electronic address: wuyuan@icdc.cn.State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Prevention and Control, Beijing, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31499177

Citation

Li, Hu, et al. "Antibiotic Resistance of Clinical Isolates of Clostridioides Difficile in China and Its Association With Geographical Regions and Patient Age." Anaerobe, vol. 60, 2019, p. 102094.
Li H, Li WG, Zhang WZ, et al. Antibiotic resistance of clinical isolates of Clostridioides difficile in China and its association with geographical regions and patient age. Anaerobe. 2019;60:102094.
Li, H., Li, W. G., Zhang, W. Z., Yu, S. B., Liu, Z. J., Zhang, X., Wu, Y., & Lu, J. X. (2019). Antibiotic resistance of clinical isolates of Clostridioides difficile in China and its association with geographical regions and patient age. Anaerobe, 60, 102094. https://doi.org/10.1016/j.anaerobe.2019.102094
Li H, et al. Antibiotic Resistance of Clinical Isolates of Clostridioides Difficile in China and Its Association With Geographical Regions and Patient Age. Anaerobe. 2019;60:102094. PubMed PMID: 31499177.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antibiotic resistance of clinical isolates of Clostridioides difficile in China and its association with geographical regions and patient age. AU - Li,Hu, AU - Li,Wen-Ge, AU - Zhang,Wen-Zhu, AU - Yu,Shuan-Bao, AU - Liu,Zheng-Jie, AU - Zhang,Xin, AU - Wu,Yuan, AU - Lu,Jin-Xing, Y1 - 2019/09/06/ PY - 2019/03/13/received PY - 2019/08/20/revised PY - 2019/08/30/accepted PY - 2019/9/10/pubmed PY - 2020/4/21/medline PY - 2019/9/10/entrez KW - Clostridioides difficile KW - Clostridium difficile KW - Multidrug resistance KW - antibiotic resistance SP - 102094 EP - 102094 JF - Anaerobe JO - Anaerobe VL - 60 N2 - It is known that antibiotic usage is associated with the development of Clostridioides difficile infection (CDI), especially clindamycin, third-generation cephalosporins, and fuoroquinolones. Antibiotic resistance rates to many antibiotics varies a lot by study. We performed a study focused on antibiotic resistance in clinical isolates of C. difficile from more widespread geographic regions across China. Of 319 C. difficile isolates tested against 11 antibiotics, 313 (98.1%) were resistant to at least one antibiotic. The highest rate of resistance was to ciprofloxacin, clindamycin, and erythromycin across all age groups, similar to previous studies. However, all isolates were susceptible to metronidazole and vancomycin. Overall the resistance rate to tested antibiotics was lower than other reports in China except for chloramphenicol and meropenem. Genotype ST37/RT017 in clade 4 was resistant to more antibiotics than other types. Unexpectedly, RT078 isolates in this study were susceptible to almost all tested antibiotics. In addition, the proportion of multi-drug resistant (MDR) isolates observed (17%) in this study was much lower than several European studies (up to 55%) and a previous study in China (78%). Although isolates from patients aged between 65 and 85 were more resistant to antibiotics in comparison to other age groups, MDR isolates were still detected in children below 2-years of age. The highest percentage of MDR isolates was determined in South China, an area that is most developed economically. The clade 4, RT017 (ST37) has been associated with outbreaks in Europe and North America and is responsible for most C. difficile infections (CDIs) in Asia. In addition, RT017 is often clindamycin and fluoroquinolone resistant. This study provided a relatively comprehensive description of antibiotic resistance of C. difficile in China, and further elucidates the epidemiology and antibiotic resistance of clinical isolates of C. difficile in China at a national level. SN - 1095-8274 UR - https://www.unboundmedicine.com/medline/citation/31499177/Antibiotic_resistance_of_clinical_isolates_of_Clostridioides_difficile_in_China_and_its_association_with_geographical_regions_and_patient_age_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1075-9964(19)30154-4 DB - PRIME DP - Unbound Medicine ER -