Clostridium difficile Infection and Patient-Specific Antimicrobial Resistance Testing Reveals a High Metronidazole Resistance Rate
Clostridium difficile Infection and Patient-Specific Antimicrobial Resistance Testing Reveals a High Metronidazole Resistance Rate
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DOI：
10.1007/s10620-017-4462-9
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发表时间：
2017-04-01
影响因子：
3.1
通讯作者：
Barkin, Jamie S.
中科院分区：
文献类型：
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作者：
Barkin, Jodie A.;Sussman, Daniel A.;Barkin, Jamie S.
艰难梭菌(Cd)感染(CDI)导致显著的发病率和死亡率，每年造成大量的医疗费用。目前的CDI治疗指南侧重于患者严重程度的临床标记物，以确定甲硝唑与万古霉素的首选抗生素方案。CD患者的耐药谱目前尚不清楚。本研究的目的是确定CD的耐药谱。这项研究包括美国各地在6个月内将粪便送往私人实验室(佐治亚州阿尔法雷塔DRG实验室)进行CD检测的所有患者。根据实验室方案，患者数据被取消识别，只有年龄、性别和邮政编码可用。所有样本都进行了PCR检测，然后进行了CD毒素A区和B区的杂交，只对CD阳性的患者进行了分析。在2743份粪便标本中，288份(10.5%)粪便标本CD呈阳性。根据协议，6人被排除在外。282例中女性193例(69.4%)，平均年龄49.4岁+/-18.7岁。在282株中，A、B毒素阳性62株，A毒素单独阳性160株，B毒素单独阳性60株。药敏结果显示，282例患者中，咪唑耐药134例(47.5%)，万古霉素耐药17例(6.1%)，咪唑和万古霉素耐药9例(3.2%)。CD阳性患者粪便DNA提取液中含有咪唑耐药基因是常见现象，而万古霉素耐药不常见。与其他感染的治疗类似，抗菌素耐药性检测应该在CDI临床决策算法中发挥作用，以实现更快、更具成本效益的患者护理。
Clostridium difficile (CD) infection (CDI) causes marked morbidity and mortality, accounting for large healthcare expenditures annually. Current CDI treatment guidelines focus on clinical markers of patient severity to determine the preferred antibiotic regimen of metronidazole versus vancomycin. The antimicrobial resistance patterns for patients with CD are currently unknown.The aim of this study was to define the antimicrobial resistance patterns for CD.This study included all patients with stools sent for CD testing to a private laboratory (DRG Laboratory, Alpharetta, Georgia) in a 6-month period from across the USA. Patient data was de-identified, with only age, gender, and zip-code available per laboratory protocol. All samples underwent PCR testing followed by hybridization for CD toxin regions A and B. Only patients with CD-positive PCR were analyzed. Antimicrobial resistance testing using stool genomic DNA evaluated presence of imidazole- and vancomycin-resistant genes using multiplex PCR gene detection.Of 2743, 288 (10.5%) stool samples were positive for CD. Six were excluded per protocol. Of 282, 193 (69.4%) were women, and average age was 49.4 +/- 18.7 years. Of 282, 62 were PCR positive for toxins A and B, 160 for toxin A positive alone, and 60 for toxin B positive alone. Antimicrobial resistance testing revealed 134/282 (47.5%) patients resistant to imidazole, 17 (6.1%) resistant to vancomycin, and 9 (3.2%) resistant to imidazole and vancomycin.CD-positive patients with presence of imidazole-resistant genes from stool DNA extract was a common phenomenon, while vancomycin resistance was uncommon. Similar to treatment of other infections, antimicrobial resistance testing should play a role in CDI clinical decision-making algorithms to enable more expedited and cost-effective delivery of patient care.