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Clostridium difficile Infection and Patient-Specific Antimicrobial Resistance Testing Reveals a High Metronidazole Resistance Rate

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Abstract

Background

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.

Aim

The aim of this study was to define the antimicrobial resistance patterns for CD.

Methods

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.

Results

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.

Conclusions

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.

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Funding

The authors report no sources of funding for the study.

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, 1120 NW 14th Street, Clinical Research Building, Suite 1116, Miami, FL, 33136, USA

    Jodie A. Barkin, Daniel A. Sussman & Jamie S. Barkin

  2. DRG Laboratory, 2001 Westside Parkway, Suite 240, Alpharetta, GA, 30004, USA

    Nimita Fifadara

Authors
  1. Jodie A. Barkin
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  2. Daniel A. Sussman
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  3. Nimita Fifadara
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  4. Jamie S. Barkin
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Corresponding author

Correspondence to Jodie A. Barkin.

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Conflict of interest

Nimita Fifadara Ph.D. is the Chief Science Officer of DRG Laboratory. Dr. Fifadara played no role in study design, data analysis, or decision to publish. The authors report no other relevant conflict of interest or disclosures.

Statement of human rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Institutional Review Board approval was obtained.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Barkin, J.A., Sussman, D.A., Fifadara, N. et al. Clostridium difficile Infection and Patient-Specific Antimicrobial Resistance Testing Reveals a High Metronidazole Resistance Rate. Dig Dis Sci 62, 1035–1042 (2017). https://doi.org/10.1007/s10620-017-4462-9

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  • DOI: https://doi.org/10.1007/s10620-017-4462-9

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