Pan-European longitudinal surveillance of antibiotic resistance among prevalent Clostridium difficile ribotypes

J. Freeman, J. Vernon, K. Morris, S. Nicholson, S. Todhunter, C. Longshaw, M. H. Wilcox, Sabine Pfeiffer, Michel Delmee, Laurent Muytjens, Johan Van Broeck, Kate Ivanova, Panagiota Maikanti-Charalampous, Otakar Nyc, Jorgen Engberg, Frederic Barbut, Helene Marchandin, Helene Jean-Pierre, Lutz Von Muller, Reinier MuttersSoren Schubert, Jana Bader, Eleni Malamou-Lada, Maria Orfanidou, Stavroula Smilakou, Erzabet Nagy, Edit Urban, Zsusanna Barna, Katalin Kristoff, Fidelma Fitzpatrick, Mairead Skally, Linda Fenelon, Frank Dennehy, Paula Mastrantonio, Claudio Farina, Carlo Farina, Maurizio Sanguinetti, Luca Masucci, Tereza Zaccaria, Anna Barbui, Giovanni Gesu, Maria Chiara Sironi, Arte Balode, Hana Pituch, Monica Oleastro, Elena Novakova, Maja Rupnik, Emilio Bouza, Helen Reigadas, Luis Alcala, Josefina Linares, Jordi Njubo, Fe Tubau, Torbjorn Noren, Andreas Widmer, Reno Frei, Martin Altwegg, Ed Kuijper, Celine Harmanus, Derek Fairley, Trefor Morris, Derrick Crook, David Griffiths, Tim Planche, Irene Monahan, John Coia, Henry Mather

Risultato della ricerca: Contributo in rivistaArticolo in rivista

149 Citazioni (Scopus)


Clostridium difficile infection remains a major healthcare burden. Until the recent introduction of fidaxomicin, antimicrobial treatments were limited to metronidazole and vancomycin. The emergence of epidemic C.difficile PCR ribotype 027 and its potential link to decreased antibiotic susceptibility highlight the lack of large-scale antimicrobial susceptibility and epidemiological data available. We report results of epidemiological and antimicrobial susceptibility investigations of C.difficile isolates collected prior to fidaxomicin introduction, establishing important baseline data. Thirty-nine sites in 22 countries submitted a total of 953 C.difficile isolates for PCR ribotyping, toxin testing, and susceptibility testing to metronidazole, vancomycin, fidaxomicin, rifampicin, moxifloxacin, clindamycin, imipenem, chloramphenicol, and tigecycline. Ninety-nine known ribotypes were identified. Ribotypes 027, 014, 001/072, and 078 were most frequently isolated in line with previous European studies. There was no evidence of resistance to fidaxomicin, and reduced susceptibility to metronidazole and vancomycin was also scarce. Rifampicin, moxifloxacin, and clindamycin resistance (13%, 40%, and 50% of total isolates, respectively) were evident in multiple ribotypes. There was a significant correlation between lack of ribotype diversity and greater antimicrobial resistance (measured by cumulative resistance score). Well-known epidemic ribotypes 027 and 001/072 were associated with multiple antimicrobial resistance, but high levels of resistance were also observed, particularly in 018 and closely related emergent ribotype 356 in Italy. This raises the possibility of antimicrobial exposure as the underlying reason for their appearance, and highlights the need for ongoing epidemiological and antimicrobial resistance surveillance.
Lingua originaleEnglish
pagine (da-a)248-248.e16
RivistaClinical Microbiology and Infection
Stato di pubblicazionePubblicato - 2015


  • Anti-Bacterial Agents
  • Antimicrobial resistance
  • Clostridium difficile
  • Drug Resistance, Bacterial
  • Enterocolitis, Pseudomembranous
  • Epidemiology
  • Europe
  • Geography
  • Humans
  • Longitudinal Studies
  • PCR ribotyping
  • Polymerase Chain Reaction
  • Population Surveillance
  • Prevalence
  • Ribotyping
  • Surveillance


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