ANTIBIOTICS: CURE AND RISK FACTOR FOR CLOSTRIDIOIDES DIFFICILE INFECTION
Keywords:
Clostridioides difficile infection, C. difficile, antimicrobial susceptibilityAbstract
Introduction: The major risk factor for acquiring an infection with Clostridioides difficile (CDI) is a long-term antibiotic treatment. Contrarily, the treatment of severe CDI cases involves application of antibiotics like vancomycin or metronidazole. Our aim was to investigate the percentage of resistance to eight antibiotics (vancomycin, metronidazole, tetracycline, clindamycin, erythromycin, imipenem, ciprofloxacin and moxifloxacin) among Clostridioides difficile isolates, indirectly evaluating the risks of acquiring CDI and the risks of therapeutic failure.
Materials and methods: Eighty isolates of Clostridioides difficile, collected from fecal samples from as many patients during a four-year period, were subject to PCR ribotyping and to antibiotic susceptibility testing by using the E test.
Results: Ribotyping of the 80 isolates of C. difficile showed that they belonged to 20 different ribotypes. The most common one was 001/072, with 40% of the isolates. All 80 of C. difficile isolates in this study showed a good sensitivity towards vancomycin and metronidazole. Resistance percentages towards tetracycline, clindamycin, erythromycin, imipenem, ciprofloxacin and moxifloxacin were 1.25%, 49%, 55%, 57%, 100% and 45%, respectively. The highest antimicrobial resistance percentages were detected in isolates taken from patients hospitalized in surgical clinics and in isolates belonging to the dominant ribotype 001/072 and hypervirulent ribotypes 017 and 027.
Conclusions: Vancomycin and metronidazole should remain the first option therapy for CDI. Therapy with clindamycin, erythromycin, imipenem, ciprofloxacin and moxifloxacin could be a risk factor for CDI. Excessive use of a particular antibiotic plays a major role in selecting and multiplying resistant clones of Clostridioides difficile strains.
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