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Five-year Pan-European, longitudinal surveillance of Clostridium difficile ribotype prevalence and antimicrobial resistance: the extended ClosER study.
Eur J Clin Microbiol Infect Dis. 2020 Jan; 39(1):169-177.EJ

Abstract

Clostridium difficile infection (CDI) has been primarily treated with metronidazole or vancomycin. High recurrence rates, the emergence of epidemic PCR ribotypes (RTs) and the introduction of fidaxomicin in Europe in 2011 necessitate surveillance of antimicrobial resistance and CDI epidemiology. The ClosER study monitored antimicrobial susceptibility and geographical distribution of C. difficile RTs pre- and post-fidaxomicin introduction. From 2011 to 2016, 28 European countries submitted isolates or faecal samples for determination of PCR ribotype, toxin status and minimal inhibitory concentrations (MICs) of metronidazole, vancomycin, rifampicin, fidaxomicin, moxifloxacin, clindamycin, imipenem, chloramphenicol and tigecycline. RT diversity scores for each country were calculated and mean MIC results used to generate cumulative resistant scores (CRSs) for each isolate and country. From 40 sites, 3499 isolates were analysed, of which 95% (3338/3499) were toxin positive. The most common of the 264 RTs isolated was RT027 (mean prevalence 11.4%); however, RT prevalence varied greatly between countries and between years. The fidaxomicin geometric mean MIC for years 1-5 was 0.04 mg/L; only one fidaxomicin-resistant isolate (RT344) was submitted (MIC ≥ 4 mg/L). Metronidazole and vancomycin geometric mean MICs were 0.46 mg/L and 0.70 mg/L, respectively. Of prevalent RTs, RT027, RT017 and RT012 demonstrated resistance or reduced susceptibility to multiple antimicrobials. RT diversity was inversely correlated with mean CRS for individual countries (Pearson coefficient r = - 0.57). Overall, C. difficile RT prevalence remained stable in 2011-2016. Fidaxomicin susceptibility, including in RT027, was maintained post-introduction. Reduced ribotype diversity in individual countries was associated with increased antimicrobial resistance.

Authors+Show Affiliations

Department of Microbiology, Leeds Teaching Hospitals Trust, Leeds, UK. jane.freeman4@nhs.net. Healthcare Associated Infections Research Group, The Leeds Institute of Medical Research, University of Leeds, Leeds, UK. jane.freeman4@nhs.net.Healthcare Associated Infections Research Group, The Leeds Institute of Medical Research, University of Leeds, Leeds, UK.Healthcare Associated Infections Research Group, The Leeds Institute of Medical Research, University of Leeds, Leeds, UK.Department of Microbiology, Leeds Teaching Hospitals Trust, Leeds, UK.Healthcare Associated Infections Research Group, The Leeds Institute of Medical Research, University of Leeds, Leeds, UK.Healthcare Associated Infections Research Group, The Leeds Institute of Medical Research, University of Leeds, Leeds, UK.Healthcare Associated Infections Research Group, The Leeds Institute of Medical Research, University of Leeds, Leeds, UK.Astellas Pharma, Inc., Chertsey, UK.Department of Microbiology, Leeds Teaching Hospitals Trust, Leeds, UK. Healthcare Associated Infections Research Group, The Leeds Institute of Medical Research, University of Leeds, Leeds, UK.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

31811507

Citation

Freeman, Jane, et al. "Five-year Pan-European, Longitudinal Surveillance of Clostridium Difficile Ribotype Prevalence and Antimicrobial Resistance: the Extended ClosER Study." European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology, vol. 39, no. 1, 2020, pp. 169-177.
Freeman J, Vernon J, Pilling S, et al. Five-year Pan-European, longitudinal surveillance of Clostridium difficile ribotype prevalence and antimicrobial resistance: the extended ClosER study. Eur J Clin Microbiol Infect Dis. 2020;39(1):169-177.
Freeman, J., Vernon, J., Pilling, S., Morris, K., Nicolson, S., Shearman, S., Clark, E., Palacios-Fabrega, J. A., & Wilcox, M. (2020). Five-year Pan-European, longitudinal surveillance of Clostridium difficile ribotype prevalence and antimicrobial resistance: the extended ClosER study. European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology, 39(1), 169-177. https://doi.org/10.1007/s10096-019-03708-7
Freeman J, et al. Five-year Pan-European, Longitudinal Surveillance of Clostridium Difficile Ribotype Prevalence and Antimicrobial Resistance: the Extended ClosER Study. Eur J Clin Microbiol Infect Dis. 2020;39(1):169-177. PubMed PMID: 31811507.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Five-year Pan-European, longitudinal surveillance of Clostridium difficile ribotype prevalence and antimicrobial resistance: the extended ClosER study. AU - Freeman,Jane, AU - Vernon,Jonathan, AU - Pilling,Sally, AU - Morris,Kirsti, AU - Nicolson,Scott, AU - Shearman,Sharie, AU - Clark,Emma, AU - Palacios-Fabrega,Jose Alejandro, AU - Wilcox,Mark, AU - ,, Y1 - 2019/12/07/ PY - 2019/05/10/received PY - 2019/09/11/accepted PY - 2019/12/8/pubmed PY - 2020/9/29/medline PY - 2019/12/8/entrez KW - Antimicrobial resistance KW - Antimicrobial susceptibility KW - Clostridium difficile KW - Ribotype prevalence KW - Surveillance SP - 169 EP - 177 JF - European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology JO - Eur J Clin Microbiol Infect Dis VL - 39 IS - 1 N2 - Clostridium difficile infection (CDI) has been primarily treated with metronidazole or vancomycin. High recurrence rates, the emergence of epidemic PCR ribotypes (RTs) and the introduction of fidaxomicin in Europe in 2011 necessitate surveillance of antimicrobial resistance and CDI epidemiology. The ClosER study monitored antimicrobial susceptibility and geographical distribution of C. difficile RTs pre- and post-fidaxomicin introduction. From 2011 to 2016, 28 European countries submitted isolates or faecal samples for determination of PCR ribotype, toxin status and minimal inhibitory concentrations (MICs) of metronidazole, vancomycin, rifampicin, fidaxomicin, moxifloxacin, clindamycin, imipenem, chloramphenicol and tigecycline. RT diversity scores for each country were calculated and mean MIC results used to generate cumulative resistant scores (CRSs) for each isolate and country. From 40 sites, 3499 isolates were analysed, of which 95% (3338/3499) were toxin positive. The most common of the 264 RTs isolated was RT027 (mean prevalence 11.4%); however, RT prevalence varied greatly between countries and between years. The fidaxomicin geometric mean MIC for years 1-5 was 0.04 mg/L; only one fidaxomicin-resistant isolate (RT344) was submitted (MIC ≥ 4 mg/L). Metronidazole and vancomycin geometric mean MICs were 0.46 mg/L and 0.70 mg/L, respectively. Of prevalent RTs, RT027, RT017 and RT012 demonstrated resistance or reduced susceptibility to multiple antimicrobials. RT diversity was inversely correlated with mean CRS for individual countries (Pearson coefficient r = - 0.57). Overall, C. difficile RT prevalence remained stable in 2011-2016. Fidaxomicin susceptibility, including in RT027, was maintained post-introduction. Reduced ribotype diversity in individual countries was associated with increased antimicrobial resistance. SN - 1435-4373 UR - https://www.unboundmedicine.com/medline/citation/31811507/Five_year_Pan_European_longitudinal_surveillance_of_Clostridium_difficile_ribotype_prevalence_and_antimicrobial_resistance:_the_extended_ClosER_study_ L2 - https://dx.doi.org/10.1007/s10096-019-03708-7 DB - PRIME DP - Unbound Medicine ER -