High Frequency of Rifampin Resistance Identified in an Epidemic Clostridium difficile Clone from a Large Teaching Hospital
High Frequency of Rifampin Resistance Identified in an Epidemic Clostridium difficile Clone from a Large Teaching Hospital
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DOI：
10.1086/596315
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发表时间：
2009-02-15
影响因子：
11.8
通讯作者：
Harrison, Lee H.
中科院分区：
文献类型：
--
作者：
Curry, Scott R.;Marsh, Jane W.;Harrison, Lee H.
背景资料。利福平用于艰难梭菌相关疾病的辅助治疗，该药物的衍生物利福昔明已成为治疗艰难梭菌相关疾病的一种有吸引力的抗菌剂。艰难梭菌对利福平耐药的报道并不常见。我们调查了来自一家大型教学医院的470株艰难梭菌对利福平的耐药率(2001-2002年为51.1%，2005年为48.9%)。利福平药敏试验采用E检验。通过tcdC基因分型和多位点可变数目串联重复序列分析鉴定了BI/NAP1艰难梭菌的流行克隆。对102个分离株的rpoB基因进行了200个碱基对的测序。获得了所有患者的利福霉素暴露数据。470株回收株中173株(36.8%)对利福平耐药，205株流行克隆株中167株(81.5%)对利福平耐药(P&t；.001)。有6种rpoB基因与利福平耐药相关。在8名接触利福霉素的患者中，有7名患者对利福平耐药艰难梭菌，而在462名未接触利福霉素的患者中，有166名患者对利福平耐药(相对风险为2.4；95%可信区间为1.8-3.3)。利福平耐药在本所艰难梭菌流行株中很常见。在艰难梭菌相关疾病发生前暴露于利福霉素是艰难梭菌感染利福平耐药的危险因素。利福昔明在我们机构治疗艰难梭菌相关疾病时可能受到限制。
Background. Rifampin is used as adjunctive therapy for Clostridium difficile-associated disease, and the drug's derivative, rifaximin, has emerged as an attractive antimicrobial for treatment of C. difficile-associated disease. Rifampin resistance in C. difficile strains has been reported to be uncommon.Methods. We examined the prevalence of rifampin resistance among 470 C. difficile isolates (51.1% during 2001-2002 and 48.9% during 2005) from a large teaching hospital. Rifampin sensitivity was performed using E-test. The epidemic BI/NAP1 C. difficile clone was identified by tcdC genotyping and multilocus variable number of tandem repeats analysis. A 200-base pair fragment of the rpoB gene was sequenced for 102 isolates. Data on rifamycin exposures were obtained for all patients.Results. Rifampin resistance was observed in 173 (36.8%) of 470 recovered isolates and 167 (81.5%) of 205 of epidemic clone isolates (P < .001). Six rpoB genotypes were associated with rifampin resistance. Of 8 patients exposed to rifamycins, 7 had rifampin-resistant C. difficile, compared with 166 of 462 unexposed patients (relative risk, 2.4; 95% confidence interval, 1.8-3.3).Conclusions. Rifampin resistance is common among epidemic clone C. difficile isolates at our institution. Exposure to rifamycins before the development of C. difficile-associated disease was a risk factor for rifampin-resistant C. difficile infection. The use of rifaximin may be limited for treatment of C. difficile-associated disease at our institution.