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Aktuelle Daten und Trends zur Antibiotikaresistenzentwicklung von Clostridium difficile

Current data and trends on the development of antibiotic resistance of Clostridium difficile

  • Leitthema
  • Published:
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Aims and scope

Zusammenfassung

Clostridium difficile ist der häufigste Erreger antibiotikaassoziierter Durchfallerkrankungen. Der Selektionsdruck durch Antibiotika begünstigt die Entwicklung und Ausbreitung multiresistenter Stämme. In der hier dargelegten retrospektiven Untersuchung wurden C.-difficile-Isolate des Universitätsklinikums des Saarlandes und von nationalen Einsendern des Konsiliarlabors phänotypisch und genotypisch charakterisiert. Als prädominante Genotypen wurden der Ribotyp 001 (18%), 014 (16%) und 027 (15%) identifiziert. Metronidazol und Vancomycin wurde Genotyp-unabhängig als sensibel getestet (99,7%). Gegenüber Rifampicin waren 96% der klinischen Isolate sensibel; dabei wurden Rifampicin-Resistenzen gehäuft beim Ribotyp 027 nachgewiesen (12%). Nur 58% bzw. 57% der Isolate waren gegenüber Clarithromycin bzw. Moxifloxacin sensibel; für die epidemisch relevanten Stämme 001, 027 und 078 war der Nachweis einer Makrolid- bzw. Fluoroquinolon-Resistenz – anders als bei sporadisch auftretenden Genotypen – besonders charakteristisch. Eine Differenzierung der Epidemiestämme allein anhand des Antibiogramms war jedoch nicht möglich. Es sollte angestrebt werden, durch Hygienemaßnahmen und einen rationalen Antibiotikaeinsatz die Zahl der C.-difficile-Infektionen (CDI) zu reduzieren und den Selektionsdruck auf multiresistente Stämme zu minimieren.

Abstract

Clostridium difficile is the most common pathogen causing antibiotic-associated diarrhea. Antibiotic therapy also favors the development and the epidemic spreading of multiresistant strains. In this present retrospective study clinical isolates from the University of Saarland Medical Center and of other German isolate referring hospitals were characterized by genotyping and antibiotic resistance testing. The most prevalent strains were ribotypes 001 (18%), 014 (16%) and 027 (15%). Sensitivity to metronidazol and vancomycin was demonstrated for 99.7 % of the clinical isolates independent of the genotype. Of the isolates 96 % were rifampicin susceptible; however, significantly more cases of rifampicin resistance were found among 027 strains (12 %). Of the isolates 58% were clarithromycin sensitive and 57% moxifloxacin sensitive. In contrast to the various sporadic genotypes the majority of epidemic strains were macrolide or fluoroquinolone resistant (001, 027 and 078); however, discrimination between epidemic strains by antibiotic resistance profiles could not be discerned. A combination of consistent adherence to hygiene management guidelines and to a prudent and rational use of antimicrobials (antibiotic stewardship) may help to reduce the total number of C. difficile infections (CDI) and also the selection of multiresistant strains. On the other hand in the collection of isolates the sensitivity towards the standard oral antibiotic agents used for C. difficile treatment appears to be unimpaired by the global changes of C. difficile resistant profiles.

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Danksagung

Diese Studie wurde unterstützt durch eine Projektförderung des Robert Koch-Instituts (RKI). Herzlichen Dank an alle einsendenden Laboratorien und Kliniken. Stellvertretend für alle technischen Mitarbeiterinnen ein besonderer Dank an S. Hornung, S. Freis, S. Loibl und M. Birke. Für die Unterstützung bei der Datenbankabfrage danken wir Frau Funkhauser und Herrn Schwelling (Fa. Dorner).

Interessenkonflikt

Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehungen hin: LvM und MH sind als Referenten für die Firma Astellas tätig; AH gibt an, dass kein Interessenkonflikt besteht.

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  1. Institut für Medizinische Mikrobiologie und Hygiene und Staatliche Medizinaluntersuchungsstelle des Saarlandes, Universitätsklinikum des Saarlandes, Kirrbergerstr., Gebäude 43, 66421, Homburg/Saar, Deutschland

    L. von Müller, A. Halfmann & M Herrmann

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  1. L. von Müller
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  2. A. Halfmann
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  3. M Herrmann
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Correspondence to L. von Müller.

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von Müller, L., Halfmann, A. & Herrmann, M. Aktuelle Daten und Trends zur Antibiotikaresistenzentwicklung von Clostridium difficile . Bundesgesundheitsbl. 55, 1410–1417 (2012). https://doi.org/10.1007/s00103-012-1556-6

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