Antimicrobial resistance in Clostridioides (Clostridium) difficile derived from humans: a systematic review and meta-analysis
Abstract Background Clostridioides (Clostridium) difficile is an important pathogen of healthcare- associated diarrhea, however, an increase in the occurrence of C. difficile infection (CDI) outside hospital settings has been reported. The accumulation of antimicrobial resistance in C. difficile can...
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doaj-4805ec620bf245ceaa73ccdb855c717f2020-11-25T03:48:38ZengBMCAntimicrobial Resistance and Infection Control2047-29942020-09-019111110.1186/s13756-020-00815-5Antimicrobial resistance in Clostridioides (Clostridium) difficile derived from humans: a systematic review and meta-analysisMohammad Sholeh0Marcela Krutova1Mehdi Forouzesh2Sergey Mironov3Nourkhoda Sadeghifard4Leila Molaeipour5Abbas Maleki6Ebrahim Kouhsari7Clinical Microbiology Research Center, Ilam University of Medical SciencesClinical Microbiology Research Center, Ilam University of Medical SciencesClinical Microbiology Research Center, Ilam University of Medical SciencesClinical Microbiology Research Center, Ilam University of Medical SciencesClinical Microbiology Research Center, Ilam University of Medical SciencesClinical Microbiology Research Center, Ilam University of Medical SciencesClinical Microbiology Research Center, Ilam University of Medical SciencesClinical Microbiology Research Center, Ilam University of Medical SciencesAbstract Background Clostridioides (Clostridium) difficile is an important pathogen of healthcare- associated diarrhea, however, an increase in the occurrence of C. difficile infection (CDI) outside hospital settings has been reported. The accumulation of antimicrobial resistance in C. difficile can increase the risk of CDI development and/or its spread. The limited number of antimicrobials for the treatment of CDI is matter of some concern. Objectives In order to summarize the data on antimicrobial resistance to C. difficile derived from humans, a systematic review and meta-analysis were performed. Methods We searched five bibliographic databases: (MEDLINE [PubMed], Scopus, Embase, Cochrane Library and Web of Science) for studies that focused on antimicrobial susceptibility testing in C. difficile and were published between 1992 and 2019. The weighted pooled resistance (WPR) for each antimicrobial agent was calculated using a random- effects model. Results A total of 111 studies were included. The WPR for metronidazole and vancomycin was 1.0% (95% CI 0–3%) and 1% (95% CI 0–2%) for the breakpoint > 2 mg/L and 0% (95% CI 0%) for breakpoint ≥32 μg/ml. Rifampin and tigecycline had a WPRs of 37.0% (95% CI 18–58%) and 1% (95% CI 0–3%), respectively. The WPRs for the other antimicrobials were as follows: ciprofloxacin 95% (95% CI 85–100%), moxifloxacin 32% (95% CI 25–40%), clindamycin 59% (95% CI 53–65%), amoxicillin/clavulanate 0% (0–0%), piperacillin/tazobactam 0% (0–0%) and ceftriaxone 47% (95% CI 29–65%). Tetracycline had a WPR 20% (95% CI 14–27%) and meropenem showed 0% (95% CI 0–1%); resistance to fidaxomicin was reported in one isolate (0.08%). Conclusion Resistance to metronidazole, vancomycin, fidaxomicin, meropenem and piperacillin/tazobactam is reported rarely. From the alternative CDI drug treatments, tigecycline had a lower resistance rate than rifampin. The high-risk antimicrobials for CDI development showed a high level of resistance, the highest was seen in the second generation of fluoroquinolones and clindamycin; amoxicillin/clavulanate showed almost no resistance. Tetracycline resistance was present in one fifth of human clinical C. difficile isolates.http://link.springer.com/article/10.1186/s13756-020-00815-5Clostridioides difficileAntimicrobial resistanceMetronidazoleVancomycinMeta-analysis |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Mohammad Sholeh Marcela Krutova Mehdi Forouzesh Sergey Mironov Nourkhoda Sadeghifard Leila Molaeipour Abbas Maleki Ebrahim Kouhsari |
spellingShingle |
Mohammad Sholeh Marcela Krutova Mehdi Forouzesh Sergey Mironov Nourkhoda Sadeghifard Leila Molaeipour Abbas Maleki Ebrahim Kouhsari Antimicrobial resistance in Clostridioides (Clostridium) difficile derived from humans: a systematic review and meta-analysis Antimicrobial Resistance and Infection Control Clostridioides difficile Antimicrobial resistance Metronidazole Vancomycin Meta-analysis |
author_facet |
Mohammad Sholeh Marcela Krutova Mehdi Forouzesh Sergey Mironov Nourkhoda Sadeghifard Leila Molaeipour Abbas Maleki Ebrahim Kouhsari |
author_sort |
Mohammad Sholeh |
title |
Antimicrobial resistance in Clostridioides (Clostridium) difficile derived from humans: a systematic review and meta-analysis |
title_short |
Antimicrobial resistance in Clostridioides (Clostridium) difficile derived from humans: a systematic review and meta-analysis |
title_full |
Antimicrobial resistance in Clostridioides (Clostridium) difficile derived from humans: a systematic review and meta-analysis |
title_fullStr |
Antimicrobial resistance in Clostridioides (Clostridium) difficile derived from humans: a systematic review and meta-analysis |
title_full_unstemmed |
Antimicrobial resistance in Clostridioides (Clostridium) difficile derived from humans: a systematic review and meta-analysis |
title_sort |
antimicrobial resistance in clostridioides (clostridium) difficile derived from humans: a systematic review and meta-analysis |
publisher |
BMC |
series |
Antimicrobial Resistance and Infection Control |
issn |
2047-2994 |
publishDate |
2020-09-01 |
description |
Abstract Background Clostridioides (Clostridium) difficile is an important pathogen of healthcare- associated diarrhea, however, an increase in the occurrence of C. difficile infection (CDI) outside hospital settings has been reported. The accumulation of antimicrobial resistance in C. difficile can increase the risk of CDI development and/or its spread. The limited number of antimicrobials for the treatment of CDI is matter of some concern. Objectives In order to summarize the data on antimicrobial resistance to C. difficile derived from humans, a systematic review and meta-analysis were performed. Methods We searched five bibliographic databases: (MEDLINE [PubMed], Scopus, Embase, Cochrane Library and Web of Science) for studies that focused on antimicrobial susceptibility testing in C. difficile and were published between 1992 and 2019. The weighted pooled resistance (WPR) for each antimicrobial agent was calculated using a random- effects model. Results A total of 111 studies were included. The WPR for metronidazole and vancomycin was 1.0% (95% CI 0–3%) and 1% (95% CI 0–2%) for the breakpoint > 2 mg/L and 0% (95% CI 0%) for breakpoint ≥32 μg/ml. Rifampin and tigecycline had a WPRs of 37.0% (95% CI 18–58%) and 1% (95% CI 0–3%), respectively. The WPRs for the other antimicrobials were as follows: ciprofloxacin 95% (95% CI 85–100%), moxifloxacin 32% (95% CI 25–40%), clindamycin 59% (95% CI 53–65%), amoxicillin/clavulanate 0% (0–0%), piperacillin/tazobactam 0% (0–0%) and ceftriaxone 47% (95% CI 29–65%). Tetracycline had a WPR 20% (95% CI 14–27%) and meropenem showed 0% (95% CI 0–1%); resistance to fidaxomicin was reported in one isolate (0.08%). Conclusion Resistance to metronidazole, vancomycin, fidaxomicin, meropenem and piperacillin/tazobactam is reported rarely. From the alternative CDI drug treatments, tigecycline had a lower resistance rate than rifampin. The high-risk antimicrobials for CDI development showed a high level of resistance, the highest was seen in the second generation of fluoroquinolones and clindamycin; amoxicillin/clavulanate showed almost no resistance. Tetracycline resistance was present in one fifth of human clinical C. difficile isolates. |
topic |
Clostridioides difficile Antimicrobial resistance Metronidazole Vancomycin Meta-analysis |
url |
http://link.springer.com/article/10.1186/s13756-020-00815-5 |
work_keys_str_mv |
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