1
|
Sun P, Pu J, Lei D, Li J, Ren X, Jin L, Pan L. Novel Aminocoumarin Derivatives against Phytopathogenic Fungi: Design, Synthesis and Structure-Activity Relationships. Chem Biodivers 2024; 21:e202400311. [PMID: 38494946 DOI: 10.1002/cbdv.202400311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/17/2024] [Accepted: 03/17/2024] [Indexed: 03/19/2024]
Abstract
Phytopathogenic fungi is the most devastating reason for the decrease of the agricultural production and food safety. To develop new fungicidal agents for resistance concerning, a novel series of aminocoumarin derivatives were synthesized and their fungicidal activity were investigated both in vitro and in vivo. Transmission electron microscope (TEM), scanning electron microscope (SEM), RNA-Seq, 3D-QSAR and molecular docking were applied to reveal the underlying anti-fungal mechanisms. Most of the compounds exhibited significant fungicidal activity. Notably, compound 10c had a more extensive fungicidal effect than positive control. TEM indicated that compound 10c could cause abnormal morphology of cell walls, vacuoles and release of cellular contents. Transcriptional analysis data indicated that 895 and 653 out of 1548 differential expressed genes (DEGs) were up-regulated and down-regulated respectively. The Go and KEGG enrichment indicated that the coumarin derivatives could induce significant changes of succinate dehydrogenase (SDH), Acetyl-coenzyme A synthetase (ACCA) and pyruvate dehydrogenase (PDH) genes, which contributed to the disorders of glucolipid metabolism and the dysfunction of mitochondrial. The results demonstrated that aminocoumarins with schiff-base as core moieties could be the promising lead compounds for the discovery of novel fungicides.
Collapse
Affiliation(s)
- Pengzhi Sun
- College of Chemistry and Chemical Engineering, Xinjiang Agricultural University, Urumqi, 830052
| | - Jiangping Pu
- College of Chemistry and Chemical Engineering, Xinjiang Agricultural University, Urumqi, 830052
| | - Dongyu Lei
- Department of Physiology, Preclinical School, Xinjiang Medical University, Urumqi, 830011, China
| | - Jiashan Li
- College of Chemistry and Chemical Engineering, Xinjiang Agricultural University, Urumqi, 830052
| | - Xingyu Ren
- College of Chemistry and Chemical Engineering, Xinjiang Agricultural University, Urumqi, 830052
| | - Lu Jin
- College of Chemistry and Chemical Engineering, Xinjiang Agricultural University, Urumqi, 830052
| | - Le Pan
- College of Chemistry and Chemical Engineering, Xinjiang Agricultural University, Urumqi, 830052
| |
Collapse
|
2
|
Molecular identification, phylogeny and antifungal susceptibilities of dematiaceous fungi isolated from human keratomycosis. J Infect Public Health 2022; 16:25-33. [PMID: 36459708 DOI: 10.1016/j.jiph.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/05/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To investigate the dematiaceous fungal profile of patients with ocular mycoses attending a tertiary eye care hospital in Coimbatore, India METHODS: The identification of dematiaceous fungus based on their morphology, their genotypes, and the measurement of the minimum inhibitory concentrations (MICs) using microdilution method of routinely used antifungal drugs were all compared. RESULTS A total of 148 dematiaceous fungi were isolated during a study period of 27 months. Isolates were confirmed as Curvularia spp. (n = 98), Exserohilum spp. (n = 32), Alternaria spp. (n = 14), Exophiala spp. (n = 2), Cladosporium sp. (n = 1) and Aureobasidium sp. (n = 1). Out of 50 well grown isolates characterized genotypically based on the amplification and sequencing of the ITS region of the ribosomal RNA gene cluster and subsequent BLAST analysis, Curvularia lunata (n = 24), C. aeria (n = 1), C. spicifera (n = 8), C. hawaiiensis (n = 1), C. maydis (n = 2), C. papendorfii (n = 2), C. geniculata (n = 3), C. tetramera (n = 2) and Exs. rostratum (n = 7) were identified. In vitro antifungal susceptibilities of the most tested dematiaceous isolates showed that voriconazole had a MIC50 of 0.25 μg ml-1, while amphotericin B had a MIC50 of 0.25 μg ml-1 for Curvularia spp. and Alternaria spp. CONCLUSION Voriconazole proved to be the most effective drug against the pigmented filamentous fungi, followed by amphotericin B, itraconazole and econazole.
Collapse
|
3
|
Atkin SD, Abid S, Foster M, Bose M, Keller A, Hollaway R, Sader HS, Greenberg DE, Finklea JD, Castanheira M, Jain R. Multidrug-resistant Pseudomonas aeruginosa from sputum of patients with cystic fibrosis demonstrates a high rate of susceptibility to ceftazidime-avibactam. Infect Drug Resist 2018; 11:1499-1510. [PMID: 30271183 PMCID: PMC6149938 DOI: 10.2147/idr.s173804] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose Ceftazidime–avibactam is a novel antimicrobial combining a third-generation cephalosporin with a non-β-lactam β-lactamase inhibitor that was recently approved to treat Gram-negative hospital- and ventilator-acquired pneumonia. The use of ceftazidime–avibactam to treat Pseudomonas aeruginosa respiratory infections in patients with cystic fibrosis (CF) has not been evaluated. In this study, we assessed the ceftazidime–avibactam susceptibility of multidrug-resistant (MDR) P. aeruginosa sputum isolates from adults with CF. Methods Sputum was collected from individuals with CF, aged ≥18 years, known to be colonized with MDR P. aeruginosa, and tested for susceptibility to 11 different antipseudomonal antimicrobial agents. Isolates were included in the analysis if they were resistant to both ceftazidime and at least one agent in ≥3 different antimicrobial categories routinely used to treat P. aeruginosa. Subject demographics and clinical characteristics were collected. Ceftazidime–avibactam-resistant isolates were screened for the presence of β-lactam-resistant mechanisms. Results Thirty-two P. aeruginosa isolates were analyzed, of which 23 isolates were sensitive to ceftazidime–avibactam (71.9%). Ten of the isolates were mucoid and 22 isolates were nonmucoid, both demonstrating >70% susceptibility to ceftazidime–avibactam. The most notable difference in the subjects with resistant strains was an older age and lower body mass index (BMI). Ceftazidime–avibactam-resistant strains showed elevated AmpC expression in >60% of the strains and loss of OprD detection in >70% of the strains. Conclusion Ceftazidime–avibactam demonstrated a significant in vitro activity against highly resistant P. aeruginosa sputum isolates from individuals with CF. Further evaluation of the cause of resistance and clinical impact of ceftazidime–avibactam in CF patients with MDR P. aeruginosa is warranted.
Collapse
Affiliation(s)
- Stan D Atkin
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA,
| | - Shadaan Abid
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA,
| | - Michael Foster
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA,
| | - Moumita Bose
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA,
| | - Ashley Keller
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA,
| | - Rita Hollaway
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - David E Greenberg
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA, .,Department of Microbiology, University of Texas Southwestern Medical Center, Dallas, TX, USA,
| | - James D Finklea
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA,
| | | | - Raksha Jain
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA, .,Department of Microbiology, University of Texas Southwestern Medical Center, Dallas, TX, USA,
| |
Collapse
|
4
|
Thornton CS, Rubin JE, Greninger AL, Peirano G, Chiu CY, Pillai DR. Epidemiological and genomic characterization of community-acquired Clostridium difficile infections. BMC Infect Dis 2018; 18:443. [PMID: 30170546 PMCID: PMC6119286 DOI: 10.1186/s12879-018-3337-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 08/16/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Clostridium difficile infection (CDI) is a major cause of morbidity and mortality in North America and Europe. The aim of this study was to identify epidemiologically-confirmed cases of community-acquired (CA)-CDI in a large North American urban center and analyze isolates using multiple genetic and phenotypic methods. METHODS Seventy-eight patients testing positive for C. difficile from outpatient clinics were further investigated by telephone questionnaire. CA-CDI isolates were characterized by antibiotic susceptibility, pulsed-field gel electrophoresis and whole genome sequencing. CA-CDI was defined as testing positive greater than 12 weeks following discharge or no previous hospital admission in conjunction with positive toxin stool testing. RESULTS 51.3% (40/78) of the patients in this study were found to have bona fide CA-CDI. The majority of patients were female (71.8% vs. 28.2%) with 50-59 years of age being most common (21.8%). Common co-morbidities included ulcerative colitis (1/40; 2.5%), Crohn's disease (3/40; 7.5%), celiac disease (2/40; 5.0%) and irritable bowel syndrome (8/40; 20.0%). However, of 40 patients with CA-CDI, 9 (29.0%) had been hospitalized between 3 and 6 months prior and 31 (77.5%) between 6 and 12 months prior. The hypervirulent North American Pulostype (NAP) 1-like (9/40; 22.5%) strain was the most commonly identified pulsotype. Whole genome sequencing of CA-CDI isolates confirmed that NAP 1-like pulsotypes are commonplace in CA-CDI. From a therapeutic perspective, there was universal susceptibility to metronidazole and vancomycin. CONCLUSIONS All CA-CDI cases had some history of hospitalization if the definition were modified to health care facility exposure in the last 12 months and is supported by the genomic analysis. This raises the possibility that even CA-CDI may have nosocomial origins.
Collapse
Affiliation(s)
- Christina S Thornton
- Department of Microbiology and Infectious Diseases, University of Calgary, Calgary, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Joseph E Rubin
- Calgary Laboratory Services, Calgary, AB, Canada.,Department of Veterinary Microbiology, University of Saskatchewan, Regina, Canada
| | - Alexander L Greninger
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA.,Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | | | - Charles Y Chiu
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA.,Department of Medicine, Division of Infectious Diseases, University of California San Francisco, San Francisco, CA, USA
| | - Dylan R Pillai
- Department of Microbiology and Infectious Diseases, University of Calgary, Calgary, AB, Canada. .,Department of Medicine, University of Calgary, Calgary, AB, Canada. .,Calgary Laboratory Services, Calgary, AB, Canada. .,Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada. .,Diagnostic and Scientific Center, Room 1W-416, 9-3535 Research Road NW, Calgary, AB, T2L 2K8, Canada.
| |
Collapse
|
5
|
Burke DG, Harrison MJ, Fleming C, McCarthy M, Shortt C, Sulaiman I, Murphy DM, Eustace JA, Shanahan F, Hill C, Stanton C, Rea MC, Ross RP, Plant BJ. Clostridium difficile carriage in adult cystic fibrosis (CF); implications for patients with CF and the potential for transmission of nosocomial infection. J Cyst Fibros 2016; 16:291-298. [PMID: 27908697 DOI: 10.1016/j.jcf.2016.09.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 09/18/2016] [Accepted: 09/22/2016] [Indexed: 01/29/2023]
Abstract
Clostridium difficile is an anaerobic Gram-positive, spore-forming, toxin-producing bacillus transmitted among humans through the faecal-oral route. Despite increasing carriage rates and the presence of C. difficile toxin in stool, patients with CF rarely appear to develop typical manifestations of C. difficile infection (CDI). In this study, we examined the carriage, toxin production, ribotype distribution and antibiotic susceptibility of C. difficile in a cohort of 60 adult patients with CF who were pre-lung transplant. C. difficile was detected in 50% (30/60) of patients with CF by culturing for the bacteria. C. difficile toxin was detected in 63% (19/30) of C. difficile-positive stool samples. All toxin-positive stool samples contained toxigenic C. difficile strains harbouring toxin genes, tcdA and tcdB. Despite the presence of C. difficile and its toxin in patient stool, no acute gastrointestinal symptoms were reported. Ribotyping of C. difficile strains revealed 16 distinct ribotypes (RT), 11 of which are known to be disease-causing including the hyper-virulent RT078. Additionally, strains RT002, RT014, and RT015, which are common in non-CF nosocomial infection were described. All strains were susceptible to vancomycin, metronidazole, fusidic acid and rifampicin. No correlation was observed between carriage of C. difficile or any characteristics of isolated strains and any recorded clinical parameters or treatment received. We demonstrate a high prevalence of hypervirulent, toxigenic strains of C. difficile in asymptomatic patients with CF. This highlights the potential role of asymptomatic patients with CF in nosocomial transmission of C. difficile.
Collapse
Affiliation(s)
- D G Burke
- APC Microbiome Institute, University College Cork, Ireland
| | - M J Harrison
- Cork Adult CF Centre, Dept. of Respiratory Medicine, Cork University Hospital, University College Cork, Ireland
| | - C Fleming
- Cork Adult CF Centre, Dept. of Respiratory Medicine, Cork University Hospital, University College Cork, Ireland
| | - M McCarthy
- Cork Adult CF Centre, Dept. of Respiratory Medicine, Cork University Hospital, University College Cork, Ireland
| | - C Shortt
- Cork Adult CF Centre, Dept. of Respiratory Medicine, Cork University Hospital, University College Cork, Ireland
| | - I Sulaiman
- Dept. of Respiratory Medicine, Cork University Hospital, University College Cork, Ireland
| | - D M Murphy
- Cork Adult CF Centre, Dept. of Respiratory Medicine, Cork University Hospital, University College Cork, Ireland
| | - J A Eustace
- Health Research Board, Clinical Research Facility, University College Cork, Ireland
| | - F Shanahan
- APC Microbiome Institute, University College Cork, Ireland
| | - C Hill
- School of Microbiology, University College Cork, Ireland
| | - C Stanton
- Teagasc Food Research Centre, Moorepark, Fermoy, Co. Cork, Ireland
| | - M C Rea
- Teagasc Food Research Centre, Moorepark, Fermoy, Co. Cork, Ireland
| | - R P Ross
- APC Microbiome Institute, University College Cork, Ireland
| | - B J Plant
- Cork Adult CF Centre, Dept. of Medicine, Cork University Hospital, University College Cork, Ireland.
| |
Collapse
|
6
|
Thitaram S, Frank J, Siragusa G, Bailey J, Dargatz D, Lombard J, Haley C, Lyon S, Fedorka-Cray P. Antimicrobial susceptibility of Clostridium difficile isolated from food animals on farms. Int J Food Microbiol 2016; 227:1-5. [DOI: 10.1016/j.ijfoodmicro.2016.03.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 02/12/2016] [Accepted: 03/14/2016] [Indexed: 01/08/2023]
|
7
|
McLain JE, Cytryn E, Durso LM, Young S. Culture-based Methods for Detection of Antibiotic Resistance in Agroecosystems: Advantages, Challenges, and Gaps in Knowledge. JOURNAL OF ENVIRONMENTAL QUALITY 2016; 45:432-40. [PMID: 27065389 DOI: 10.2134/jeq2015.06.0317] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Various culture-based methodologies are used in assessment of antibiotic resistance in samples collected in agroecosystems. Culture-based methods commonly involve isolating target bacteria on general or selective media and assessing growth in response to specific concentrations of antibiotics. The advantages of culture-based methods are multifold. In particular, isolation of bacteria is key to understanding phenotypic characteristics of isolates and their resistance patterns, and most national and international antibiotic resistance monitoring projects are isolate based. This review covers current knowledge of bacterial groups and antibiotics commonly targeted in resistance studies using bacterial culture and discusses the range in methods used, data interpretation, and factors supporting and confounding the use of culture-based methods in assessment of antibiotic resistance. Gaps in knowledge related to study design and resistance databases are discussed. Finally, a case is made for the integration of culture-based and molecular methods to better inform our understanding of antibiotic resistance in agroecosystems.
Collapse
|
8
|
Lay CL, Dridi L, Bergeron MG, Ouellette M, Fliss I. Nisin is an effective inhibitor of Clostridium difficile vegetative cells and spore germination. J Med Microbiol 2016; 65:169-175. [DOI: 10.1099/jmm.0.000202] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Christophe Le Lay
- STELA Dairy Research Centre, Institute of Nutrition and Functional Foods, Université Laval, Québec City, QC, Canada
- Centre de recherche en infectiologie de l'Université Laval, Axe Maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec, Québec City, QC, Canada
- Département de microbiologie-infectiologie et d'immunologie, Faculté de médecine, Université Laval, Québec City, QC, Canada
| | - Larbi Dridi
- Centre de recherche en infectiologie de l'Université Laval, Axe Maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec, Québec City, QC, Canada
- Département de microbiologie-infectiologie et d'immunologie, Faculté de médecine, Université Laval, Québec City, QC, Canada
| | - Michel G. Bergeron
- Centre de recherche en infectiologie de l'Université Laval, Axe Maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec, Québec City, QC, Canada
- Département de microbiologie-infectiologie et d'immunologie, Faculté de médecine, Université Laval, Québec City, QC, Canada
| | - Marc Ouellette
- Centre de recherche en infectiologie de l'Université Laval, Axe Maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec, Québec City, QC, Canada
- Département de microbiologie-infectiologie et d'immunologie, Faculté de médecine, Université Laval, Québec City, QC, Canada
| | - Ismaı¨l Fliss
- STELA Dairy Research Centre, Institute of Nutrition and Functional Foods, Université Laval, Québec City, QC, Canada
| |
Collapse
|
9
|
Richardson C, Kim P, Lee C, Bersenas A, Weese JS. Comparison of Clostridium difficile isolates from individuals with recurrent and single episode of infection. Anaerobe 2015; 33:105-8. [PMID: 25769665 DOI: 10.1016/j.anaerobe.2015.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 02/23/2015] [Accepted: 03/09/2015] [Indexed: 12/22/2022]
Abstract
PURPOSE Recurrent Clostridium difficile infection (CDI) is an increasing problem, yet reasons for this are poorly understood. Attention has been paid to the role of strain, with conflicting association of ribotype 027 and recurrences. METHODS Stool samples and medical records data were collected from 60 patients: 27 with recurrent CDI and 33 with single episode CDI. C. difficile was isolated and ribotyped, and minimum inhibitory concentrations of metronidazole and vancomycin were determined by Etest. RESULTS Twenty-seven ribotypes were identified, but only four (027, 014 and two internally designated strains) were found in more than one patient. Ribotype 027 predominated and was significantly over-represented in the recurrent CDI group (70%) versus the single episode CDI group (30%) (P = 0.004). Female gender and the presence of ribotype 027 were significantly associated with recurrent CDI in the multivariable model. Metronidazole MICs for recurrent isolates were significantly higher compared to single episode isolates (P ≤ 0.024). A general linear model indicated that the difference in MIC was associated with ribotype 027 (P = 0.0023), not whether the isolate was from recurrent or single episode disease (P = 0.25). CONCLUSIONS Ribotype 027 was associated with recurrent disease. While there was no difference in the prevalence of metronidazole resistance, isolates from recurrent CDI patients had significantly higher metronidazole MICs, because of higher MICs in ribotype 027. This study provides further support to the clinical importance of ribotype 027 and raises questions about the potential impact of decreased metronidazole susceptibility on the pathophysiology of recurrent CDI.
Collapse
Affiliation(s)
- Connor Richardson
- Department of Clinical Studies, University of Guelph, Guelph, Canada
| | - Peter Kim
- Department of Mathemetics and Statistics, University of Guelph, Guelph, Canada; St Joseph's Healthcare, 50 Charlton Ave E, 424 Luke Wing, Hamilton, Canada
| | - Christine Lee
- Department of Pathology and Molecular Medicine, McMaster University, St Joseph's Healthcare, 50 Charlton Ave E, 424 Luke Wing, Hamilton, Canada
| | - Alexa Bersenas
- Department of Clinical Studies, University of Guelph, Guelph, Canada
| | - J Scott Weese
- Department of Pathobiology, University of Guelph, Guelph, Canada; Centre for Public Health and Zoonoses, University of Guelph, Guelph, Canada.
| |
Collapse
|
10
|
Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC, Pepin J, Wilcox MH. Clinical Practice Guidelines for Clostridium difficile Infection in Adults: 2010 Update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol 2015; 31:431-55. [PMID: 20307191 DOI: 10.1086/651706] [Citation(s) in RCA: 2180] [Impact Index Per Article: 242.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Since publication of the Society for Healthcare Epidemiology of America position paper onClostridium difficileinfection in 1995, significant changes have occurred in the epidemiology and treatment of this infection.C. difficileremains the most important cause of healthcare-associated diarrhea and is increasingly important as a community pathogen. A more virulent strain ofC. difficilehas been identified and has been responsible for more-severe cases of disease worldwide. Data reporting the decreased effectiveness of metronidazole in the treatment of severe disease have been published. Despite the increasing quantity of data available, areas of controversy still exist. This guideline updates recommendations regarding epidemiology, diagnosis, treatment, and infection control and environmental management.
Collapse
Affiliation(s)
- Stuart H Cohen
- Department of Internal Medicine, Division of Infectious and Immunologic Diseases, University of California Davis Medical Center, Sacramento, California, USA
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Mizumura N, Demura K, Kawasaki M, Okumura S, Toyoda S, Imagawa A, Ogawa M, Ohba K, Kameyama M. Continuous Administration of Vancomycin through a Long Intestinal Tube for Clostridium difficile Infection. Intern Med 2015; 54:1559-62. [PMID: 26073250 DOI: 10.2169/internalmedicine.54.4026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 76-year-old previously healthy Japanese man experienced severe diarrhea (8,000 mL per day) after undergoing laparotomy for small bowel obstruction and was diagnosed with Clostridium difficile infection. Although he developed a maculopapular rash secondary to the systemic absorption of enteral vancomycin (VCM), the patient was successfully treated with the continuous administration of VCM through a long intestinal tube placed in the terminal ileum. This method ensured the reliable delivery of VCM to the colon, while the continuous administration maintained high fecal levels of the drug. This treatment approach is an effective minimally invasive option for patients with severe diarrhea.
Collapse
|
12
|
In vitro susceptibility of filamentous fungi from mycotic keratitis to azole drugs. J Mycol Med 2014; 25:44-9. [PMID: 25541256 DOI: 10.1016/j.mycmed.2014.10.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 09/29/2014] [Accepted: 10/20/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The in vitro antifungal activities of azole drugs viz., itraconazole, voriconazole, ketoconazole, econazole and clotrimazole were investigated in order to evaluate their efficacy against filamentous fungi isolated from mycotic keratitis. METHODS The specimen collection was carried out from fungal keratitis patients attending Aravind eye hospital and Post-graduate institute of ophthalmology, Coimbatore, India and was subsequently processed for the isolation of fungi. The dilutions of antifungal drugs were prepared in RPMI 1640 medium. Minimum inhibitory concentrations (MICs) were determined and MIC50 and MIC90 were calculated for each drug tested. RESULTS A total of 60 fungal isolates were identified as Fusarium spp. (n=30), non-sporulating moulds (n=9), Aspergillus flavus (n=6), Bipolaris spp. (n=6), Exserohilum spp. (n=4), Curvularia spp. (n=3), Alternaria spp. (n=1) and Exophiala spp. (n=1). The MICs of ketoconazole, clotrimazole, voriconazole, econazole and itraconazole for all the fungal isolates ranged between 16 μg/mL and 0.03 μg/mL, 4 μg/mL and 0.015 μg/mL, 8 μg/mL and 0.015 μg/mL, 8 μg/mL and 0.015 μg/mL and 32 μg/mL and 0.06 μg/mL respectively. From the MIC50 and MIC90 values, it could be deciphered that in the present study, clotrimazole was more active against the test isolates at lower concentrations (0.12-5 μg/mL) when compared to other drugs tested. CONCLUSION The results suggest that amongst the tested azole drugs, clotrimazole followed by voriconazole and econazole had lower MICs against moulds isolated from mycotic keratitis.
Collapse
|
13
|
Poxton IR. The changing faces of Clostridium difficile: a personal reflection of the past 34 years. Anaerobe 2013; 24:124-7. [PMID: 23296302 DOI: 10.1016/j.anaerobe.2012.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 12/15/2012] [Indexed: 11/26/2022]
Abstract
Late in 1978 my boss gave me a folder with "Clostridium difficile (diffikilé)" written on it. Inside were a few recent and now classic papers by Bartlett, Larson and co. It was suggested that this might be an interesting research topic. So began a continuing adventure which has resulted in at least 50 publications from my group. Over the years we have made several important contributions to the field. Beginning in 1982 we showed that C. difficile was a common cause of community-acquired infection! During the next few years we did extensive structural studies on the bacterium. This culminated in 1984 with a fingerprinting study (by immunoblotting surface antigens), on Swedish strains supplied by Carl-Erik Nord, which was probably the first study to demonstrate that C. difficile was really an infectious agent. This was later reinforced with strains sent from Amsterdam by Ed Kuijper. Later in the 1980s, in a study of recurrent disease, we showed that ca. 50% of recurrences were due to infection with a different strain. During my term as chair of the European Study Group for C. difficile, we began to define the status of C. difficile infection (CDI) in Europe and develop guidance for diagnosis and treatment. Recently we utilised our extensive culture collection, with isolates from the 1970s to the present, to observe how epidemiology has been driven largely by antibiotic usage. We have now come full circle: in the early years C. difficile infection was caused by many different strains. Then in the period beginning in the 1990s, characterised by often-large outbreaks and poor infection control, disease was caused by a few endemic strains highlighted by the 027/NAP1/BI pandemic. Now in a much-improved local situation, we are seeing again that the majority of cases (largely sporadic) is caused by multiple types. Current studies range from molecular studies on toxin and spore production, immune responses, novel observations on CDI in children, to what is the best way of decontaminating the anaerobe laboratory.
Collapse
Affiliation(s)
- Ian R Poxton
- Medical Microbiology, University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, EH16 4SB, UK.
| |
Collapse
|
14
|
Norén T, Alriksson I, Åkerlund T, Burman L, Unemo M. In vitro susceptibility to 17 antimicrobials of clinical Clostridium difficile isolates collected in 1993–2007 in Sweden. Clin Microbiol Infect 2010; 16:1104-10. [DOI: 10.1111/j.1469-0691.2009.03048.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
15
|
Taori SK, Hall V, Poxton IR. Changes in antibiotic susceptibility and ribotypes in Clostridium difficile isolates from southern Scotland, 1979–2004. J Med Microbiol 2010; 59:338-344. [DOI: 10.1099/jmm.0.014829-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
An increase in the incidence of clinical cases of Clostridium difficile infection has been reported in recent years, but few studies have examined changes in molecular epidemiology and antibiotic resistance over a long period of time. A collection of 179 isolates of C. difficile obtained from symptomatic adult patients in southern Scotland between 1979 and 2004 was used to determine changes in the prevalence of epidemiological types and antibiotic susceptibilities to common antibiotics. PCR ribotyping and MIC determination were performed on all isolates. A total of 56 different ribotypes were identified, among which ribotype 002 was the commonest type overall (14 .0%), followed by ribotypes 014 (7.3 %), 012 (5 .0%), 015 (5.0 %), 020 (5 .0%) and 001 (4.5 %). Ribotype 078 was also identified. The 10 commonest ribotypes comprised 55 % of the total isolates. Ribotype 001 increased in prevalence from 1.5 to 12.2 % over the study years, whereas the prevalence of ribotype 012 decreased from 8.7 to 2 .0%. Resistance to clindamycin, erythromycin and ceftriaxone was found in 95.5, 14.0 and 13.4 % of isolates, respectively. Resistance to vancomycin or metronidazole was not detected. Thirty-two (17.9 %) and 14 (7.8 %) isolates were resistant to two and three or more antibiotics, respectively. Ribotype 001 displayed maximum resistance, with 50 % of isolates resistant to erythromycin, moxifloxacin and ceftriaxone, and 100 % resistant to clindamycin. Over the 26 years of the study, antibiotic resistance and ribotype prevalence have changed, and antibiotic pressures may have been the major driver of this change.
Collapse
Affiliation(s)
- Surabhi K. Taori
- Medical Microbiology, Centre for Infectious Diseases, University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, UK
| | - Val Hall
- Anaerobe Reference Laboratory, NPHS, Microbiology Cardiff, University Hospital of Wales, Cardiff, UK
| | - Ian R. Poxton
- Medical Microbiology, Centre for Infectious Diseases, University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, UK
| |
Collapse
|
16
|
Huang H, Weintraub A, Fang H, Nord CE. Antimicrobial resistance in Clostridium difficile. Int J Antimicrob Agents 2009; 34:516-22. [PMID: 19828299 DOI: 10.1016/j.ijantimicag.2009.09.012] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Accepted: 09/22/2009] [Indexed: 02/07/2023]
Abstract
Clostridium difficile is the leading cause of hospital-acquired diarrhoea and the number of outbreaks has risen markedly since 2003. The emergence and spread of resistance in C. difficile is complicating treatment and prevention. Most isolates are still susceptible to vancomycin and metronidazole (MTZ), however transient and heteroresistance to MTZ have been reported. The prevalence of resistance to other antimicrobial agents is highly variable in different populations and in different countries, ranging from 0% to 100%. Isolates of common polymerase chain reaction (PCR) ribotypes are more resistant than uncommon ribotypes. Most of the resistance mechanisms that have been identified in C. difficile are similar to those in other Gram-positive bacteria, including mutation, selection and acquisition of the genetic information that encodes resistance. Better antibiotic stewardship and infection control are needed to prevent further spread of resistance in C. difficile.
Collapse
Affiliation(s)
- Haihui Huang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
| | | | | | | |
Collapse
|
17
|
Leffler DA, Lamont JT. Treatment of Clostridium difficile-associated disease. Gastroenterology 2009; 136:1899-912. [PMID: 19457418 DOI: 10.1053/j.gastro.2008.12.070] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Revised: 12/12/2008] [Accepted: 12/22/2008] [Indexed: 02/07/2023]
Abstract
Clostridium difficile infection is an increasing burden to the health care system, totaling more than $1 billion/year in the United States. Treatment of patients with C difficile infection with metronidazole or vancomycin reduces morbidity and mortality, although the number of patients that do not respond to metronidazole is increasing. Despite initial response rates of greater than 90%, 15%-30% of patients have a relapse in symptoms after successful initial therapy, usually in the first few weeks after treatment is discontinued. Failure to develop specific antibody response has recently been identified as a critical factor in recurrence. The review discusses the different management strategies for initial and recurrent symptomatic C difficile infections.
Collapse
Affiliation(s)
- Daniel A Leffler
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
| | | |
Collapse
|
18
|
Poilane I, Bert F, Cruaud P, Nicolas-Chanoine MH, Collignon A. Évaluation de l'antibiogramme par diffusion en milieu gélosé pour le dépistage de souches de Clostridium difficile de sensibilité diminuée aux antibiotiques. ACTA ACUST UNITED AC 2007; 55:429-33. [PMID: 17905536 DOI: 10.1016/j.patbio.2007.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2007] [Accepted: 07/05/2007] [Indexed: 10/22/2022]
Abstract
AIM In vitro determination of Clostridium difficile susceptibility to antibiotics is not routinely performed. The aim of this study was to evaluate the performance of antibiotic susceptibility determination with the disk diffusion method for screening C. difficile isolates with decreased susceptibility to antibiotics. METHODS Thirty-six C. difficile isolates (toxigenic or not) isolated in 2005 and 2006 from three hospitals Assistance publique-Hôpitaux de Paris (Jean-Verdier, René-Muret, Beaujon) were studied by disk diffusion method with 14 antibiotics. Mueller-Hinton agar supplemented with sheep blood (Bio-Rad*) were swabbed with a C. difficile suspension at 1 McFarland. To check the results obtained with the disk diffusion method, Minimal Inhibitory Concentration (MIC) were performed respectively with E-test for glycopeptides and metronidazole and with the agar dilution reference method and E-test for new molecules with a potential activity against anaerobes: imipenem, ertapenem, linezolid and moxifloxacin. RESULTS The decreased susceptibility (resistant and intermediate) observed was 40% for amoxicillin-clavulanate, 60% for piperacillin-tazobactam, 100% for ceftriaxone, 81% for imipenem, 61% for ertapenem, 2% for chloramphenicol, 34% for erythromycin, 90% for lincomycin, 2% for linezolid, 98% for levofloxacin, 17% for moxifloxacin and 0% for vancomycin, teicoplanin and metronidazole. The results obtained with the disk diffusion method were compared to MICs obtained with E-test and reference method. CONCLUSION The disk diffusion method seems to be a good method to detect isolates suspected to have a decreased susceptibility and consequently to reduce MIC determinations.
Collapse
Affiliation(s)
- I Poilane
- Laboratoire de microbiologie, hôpital Jean-Verdier, Assistance publique-Hôpitaux de Paris, avenue du 14-Juillet, 93140 Bondy, France.
| | | | | | | | | |
Collapse
|
19
|
Abstract
Clostridium difficile is an important nosocomial pathogen and the most frequently diagnosed cause of infectious hospital-acquired diarrhoea. Toxigenic strains usually produce toxin A and toxin B, which are the primary virulence factors of C. difficile. Some recently described strains produce an additional toxin, an adenosine-diphosphate ribosyltransferase known as binary toxin, the role of which in pathogenicity is unknown. There has been concern about the emergence of a hypervirulent fluoroquinolone-resistant strain of C. difficile in North America and Europe. The use of fluoroquinolone antimicrobials appears to be acting as a selective pressure in the emergence of this strain. In this review, we describe the current state of knowledge about C. difficile as a cause of diarrhoeal illness.
Collapse
Affiliation(s)
- B Elliott
- Microbiology and Immunology, The University of Western Australia, Perth, Western Australia, Australia
| | | | | | | |
Collapse
|
20
|
Rea MC, Clayton E, O'Connor PM, Shanahan F, Kiely B, Ross RP, Hill C. Antimicrobial activity of lacticin 3,147 against clinical Clostridium difficile strains. J Med Microbiol 2007; 56:940-946. [PMID: 17577060 DOI: 10.1099/jmm.0.47085-0] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Clostridium difficile-associated diarrhoea (CDAD) is the most common hospital-acquired diarrhoea, and is a major type of gastroenteritis infection in nursing homes and facilities for the elderly. In this study the antimicrobial activity of the two-component lantibiotic, lacticin 3,147, against a range of genetically distinct C. difficile isolates was studied. The bacteriocin exhibited an MIC(50) of 3.6 microg ml(-1) for 10 genetically distinct C. difficile strains isolated from healthy subjects, inflammatory bowel disease patients and culture collection strains. In time-kill studies, 10(6) c.f.u. ml(-1) C. difficile ATCC 42,593 and CDAD isolate DPC 6,220 were killed within 120 or 20 min incubation, respectively, at a concentration of 6 microg lacticin ml(-1). Interestingly, addition of lacticin 3,147 to exponentially growing cells of C. difficile ATCC 43,593 caused rapid lysis of the cells after an initial lag phase, as measured by the concomitant release of the intracellular enzyme, acetate kinase. The addition of a food-grade, milk-based lacticin containing powder to faecal fermentation demonstrated that lacticin is effective in completely eliminating 10(6) c.f.u. C. difficile ml(-1) from a model faecal environment within 30 min when present at concentrations as low as 18 microg ml(-1). While other culturable microflora such as total anaerobes, bacteroides, total non-spore-forming anaerobes and total Gram-negative anaerobes were unaffected, populations of lactobacilli and bifidobacteria were reduced by 3 log cycles at bacteriocin levels sufficient to eliminate over 10(6) C. difficile. In light of these findings, the potential of lacticin 3,147 for treatment of CDAD is discussed.
Collapse
Affiliation(s)
- Mary C Rea
- Alimentary Pharmabiotic Centre, University College, Cork, Ireland
- Teagasc, Biotechnology Centre, Moorepark Food Research Centre, Moorepark, Fermoy, Cork, Ireland
| | - Evelyn Clayton
- Alimentary Pharmabiotic Centre, University College, Cork, Ireland
- Teagasc, Biotechnology Centre, Moorepark Food Research Centre, Moorepark, Fermoy, Cork, Ireland
| | - Paula M O'Connor
- Alimentary Pharmabiotic Centre, University College, Cork, Ireland
- Teagasc, Biotechnology Centre, Moorepark Food Research Centre, Moorepark, Fermoy, Cork, Ireland
| | - Fergus Shanahan
- Department of Medicine, University College, Cork, Ireland
- Alimentary Pharmabiotic Centre, University College, Cork, Ireland
| | | | - R Paul Ross
- Alimentary Pharmabiotic Centre, University College, Cork, Ireland
- Teagasc, Biotechnology Centre, Moorepark Food Research Centre, Moorepark, Fermoy, Cork, Ireland
| | - Colin Hill
- Department of Microbiology, University College, Cork, Ireland
- Alimentary Pharmabiotic Centre, University College, Cork, Ireland
| |
Collapse
|
21
|
Mutlu E, Wroe AJ, Sanchez-Hurtado K, Brazier JS, Poxton IR. Molecular characterization and antimicrobial susceptibility patterns of Clostridium difficile strains isolated from hospitals in south-east Scotland. J Med Microbiol 2007; 56:921-929. [PMID: 17577057 DOI: 10.1099/jmm.0.47176-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Clostridium difficile isolates (n=149) collected in south-east Scotland between August and October 2005 were typed by four different methods and their susceptibility to seven different antibiotics was determined. The aims were to define the types of strain occurring in this region and to determine whether there were any clonal relationships among them with respect to genotype and antibiotic resistance pattern. Ribotyping revealed that 001 was the most common type (n=113, 75.8 %), followed by ribotype 106 (12 isolates, 8.1 %). The majority of the isolates (96.6 %, n=144) were of toxinotype 0, with two toxinotype V isolates and single isolates of toxinotypes I, IV and XIII. PCR and restriction analysis of the fliC gene from 147 isolates gave two restriction patterns: 145 of pattern VII and two of pattern I. Binary toxin genes were detected in only three isolates: two isolates of ribotype 126, toxinotype V, and one isolate of ribotype 023, toxinotype IV. S-types showed more variation, with 64.5 % (n=40) of the common S-type (4939) and 21 % (n=13) of S-type 4741, with six other S-types (one to three isolates each). All ribotype 001 isolates were of the same S-type (4939), with three isolates of other ribotypes being this S-type. No resistance was found to metronidazole or vancomycin, with resistance to tetracycline only found in 4.3 % of the isolates. A high proportion of isolates were resistant to clindamycin (62.9 %), moxifloxacin, ceftriaxone (both 87.1 %) and erythromycin (94.8 %). Resistance to three antibiotics (erythromycin, clindamycin and ceftriaxone) was seen in 66 isolates, with erythromycin, ceftriaxone and moxifloxacin resistance seen in 96 isolates. Resistance to all four of these antibiotics was found in 62 isolates and resistance to five (the above plus tetracycline) in one isolate: a ribotype 001, toxinotype 0 strain. Whilst ribotype 001 was the most commonly encountered type, there was no evidence of clonal relationships when all other typing and antibiotic resistance patterns were taken into account.
Collapse
Affiliation(s)
- Esvet Mutlu
- Medical Microbiology, Centre for Infectious Diseases, University of Edinburgh College of Medicine and Veterinary Medicine, The Chancellors Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Allison J Wroe
- Medical Microbiology, Centre for Infectious Diseases, University of Edinburgh College of Medicine and Veterinary Medicine, The Chancellors Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Karla Sanchez-Hurtado
- Medical Microbiology, Centre for Infectious Diseases, University of Edinburgh College of Medicine and Veterinary Medicine, The Chancellors Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Jon S Brazier
- Anaerobe Reference Laboratory, NPHS Microbiology Cardiff, University Hospital of Wales, Cardiff, UK
| | - Ian R Poxton
- Medical Microbiology, Centre for Infectious Diseases, University of Edinburgh College of Medicine and Veterinary Medicine, The Chancellors Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| |
Collapse
|
22
|
Zheng L, Citron DM, Genheimer CW, Sigmon SF, Carman RJ, Lyerly DM, Goldstein EJC. Molecular characterization and antimicrobial susceptibilities of extra-intestinal Clostridium difficile isolates. Anaerobe 2007; 13:114-20. [PMID: 17531516 DOI: 10.1016/j.anaerobe.2007.04.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2006] [Revised: 12/15/2006] [Indexed: 11/26/2022]
Abstract
Amongst 25 extra-intestinal clinical isolates of Clostridium difficile, A(+)B(+) (72%) and A(-)B(+) (4%) toxigenic phenotypes, as well as the non-toxigenic phenotype (A(-)B(-)) (24%), were identified. The A(-)B(-) isolates did not express toxin, yet carried part of the tcdA and tcdB gene and are of a previously unreported toxinotype. Six A(+)B(+) isolates also carried binary toxin genes. Resistance to erythromycin (20%), clindamycin (48%), tetracycline (16%), moxifloxacin (16%) and imipenem (11%) occurred but with no apparent correlation to phenotype. None of the strains was resistant to vancomycin or metronidazole. Imipenem-resistance decreased by EDTA, but susceptibility to meropenem suggests the presence of an imipenem specific metalloenzyme.
Collapse
Affiliation(s)
- Limin Zheng
- TechLab, Inc., 2001 Kraft Drive, Blacksburg, VA 24060, USA.
| | | | | | | | | | | | | |
Collapse
|
23
|
McFarland LV, Beneda HW, Clarridge JE, Raugi GJ. Implications of the changing face of Clostridium difficile disease for health care practitioners. Am J Infect Control 2007; 35:237-53. [PMID: 17482995 DOI: 10.1016/j.ajic.2006.06.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2006] [Revised: 06/19/2006] [Accepted: 06/20/2006] [Indexed: 01/19/2023]
Abstract
Recent reported outbreaks of Clostridium difficile-associated disease in Canada have changed the profile of C difficile infections. Historically, C difficile disease was thought of mainly as a nosocomial disease associated with broad-spectrum antibiotics, and the disease was usually not life threatening. The emergence of an epidemic strain, BI/NAP1/027, which produces a binary toxin in addition to the 2 classic C difficile toxins A and B and is resistant to some fluoroquinolones, was associated with large numbers of cases with high rates of mortality. Recently, C difficile has been reported more frequently in nonhospital-based settings, such as community-acquired cases. The C difficile disease is also being reported in populations once considered of low risk (children and young healthy women). In addition, poor response to metronidazole treatment is increasing. Faced with an increasing incidence of C difficile infections and the changing profile of patients who become infected, this paper will reexamine the current concepts on the epidemiology and treatment of C difficile-associated disease, present new hypotheses for risk factors, examine the role of spores in the transmission of C difficile, and provide recommendations that may enhance infection control practices.
Collapse
Affiliation(s)
- Lynne V McFarland
- From the Department of Health Services Research and Development, Veterans Administration Puget Sound Health Care System, Seattle, WA 98101, USA.
| | | | | | | |
Collapse
|
24
|
Peled N, Pitlik S, Samra Z, Kazakov A, Bloch Y, Bishara J. Predicting Clostridium difficile toxin in hospitalized patients with antibiotic-associated diarrhea. Infect Control Hosp Epidemiol 2007; 28:377-81. [PMID: 17385141 DOI: 10.1086/513723] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2006] [Accepted: 12/12/2006] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Clostridium difficile infection is implicated in 20%-30% of cases of antibiotic-associated diarrhea. Studying hospitalized patients who received antibiotic therapy and developed diarrhea, our objective was to compare the clinical characteristics of patients who developed C. difficile-associated diarrhea (CDAD) with those of patients with a negative result of a stool assay for C. difficile toxin. METHODS A prospective study was done with a cohort of 217 hospitalized patients who had received antibiotics and developed diarrhea. Patients with CDAD were defined as patients who had diarrhea and a positive result for C. difficile toxin A/B by an enzyme immunoassay of stool. The variables that yielded a significant difference on univariate analysis between patients with a positive assay result and patients with a negative assay result were entered into a logistic regression model for prediction of C. difficile toxin.Setting. A 900-bed tertiary care medical center. RESULTS Of 217 patients, 52 (24%) had a positive result of assay for C. difficile toxin A/B in their stool. The logistic regression model included impaired functional capacity, watery diarrhea, use of a proton pump inhibitor, use of a histamine receptor blocker, leukocytosis, and hypoalbuminemia. The area under the receiver operating characteristic curve for the model as a predictor of a positive result for the stool toxin assay was 0.896 (95% confidence interval, 0.661-1.000; P<.001), with 95% specificity and 68% sensitivity. CONCLUSIONS Our results may help clinicians to predict the risk of CDAD in hospitalized patients with antibiotic-associated diarrhea, to guide careful, specific empirical therapy, and to direct early attention to infection control issues.
Collapse
Affiliation(s)
- Nir Peled
- Institute of Pulmonology, Rabin Medical Center, Beilinson Hospital, Israel
| | | | | | | | | | | |
Collapse
|
25
|
Aspevall O, Lundberg A, Burman LG, Akerlund T, Svenungsson B. Antimicrobial susceptibility pattern of Clostridium difficile and its relation to PCR ribotypes in a Swedish university hospital. Antimicrob Agents Chemother 2006; 50:1890-2. [PMID: 16641471 PMCID: PMC1472208 DOI: 10.1128/aac.50.5.1890-1892.2006] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
All 238 Clostridium difficile isolates were susceptible to metronidazole and vancomycin, whereas 84% and 1% were resistant to clindamycin and fusidic acid. Etest MICs for metronidazole were lower than agar dilution MICs (P < 0.01) but without difference in susceptible-intermediate-resistant categorization. No particular PCR ribotype was associated with clindamycin or fusidic acid resistance.
Collapse
Affiliation(s)
- Olle Aspevall
- Department of Clinical Microbiology, Akademiska University Hospital, SE-751 85 Uppsala, Sweden.
| | | | | | | | | |
Collapse
|
26
|
Samore MH, Venkataraman L, DeGirolami PC, Merrigan MM, Johnson S, Gerding DN, Carmeli Y, Harbarth S. Genotypic and Phenotypic Analysis ofClostridium difficileCorrelated with Previous Antibiotic Exposure. Microb Drug Resist 2006; 12:23-8. [PMID: 16584304 DOI: 10.1089/mdr.2006.12.23] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To analyze Clostridium difficile susceptibility results and genotypes in relation to antibiotic exposures that precipitated C. difficile-associated diarrhea (CDAD), we examined 83 nosocomial C. difficile isolates recovered at a tertiary care center in Boston, Massachusetts. MICs were determined by E-test methodology using modified Brucella agar. Isolates were genotyped by pulsed-field gel electrophoresis and restriction enzyme analysis. Antibiotic susceptibilities were: ciprofloxacin (0%), clindamycin (59%), trovafloxacin (63%), ceftriaxone (73%), piperacillin/tazobactam (100%), metronidazole (100%), and vancomycin (100%). The two most common strain groups, isolated from a total of 33 patients, were much more likely to be resistant to clindamycin, erythromycin, and trovafloxacin than other strain groups [79% (26 of 33) versus 2% (1 of 50), respectively]. Clindamycin exposure was strongly associated with CDAD caused by isolates that exhibited multiple resistance to clindamycin, erythromycin, and trovafloxacin (prevalence odds ratio, 4.2; 95% confidence interval, 1.1-16.8), whereas other antimicrobials did not yield significant associations. Resistance of specific C. difficile strains to clindamycin and other antimicrobial agents may contribute to their hospital dissemination and explain, in part, the propensity of clindamycin to trigger nosocomial outbreaks.
Collapse
Affiliation(s)
- Matthew H Samore
- VA Salt Lake City Health Care System, and Division of Clinical Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA.
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Bishara J, Bloch Y, Garty M, Behor J, Samra Z. Antimicrobial resistance of Clostridium difficile isolates in a tertiary medical center, Israel. Diagn Microbiol Infect Dis 2006; 54:141-4. [PMID: 16406180 DOI: 10.1016/j.diagmicrobio.2005.09.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2005] [Revised: 09/23/2005] [Accepted: 09/26/2005] [Indexed: 11/27/2022]
Abstract
The antimicrobial susceptibilities of 49 Clostridium difficile isolates obtained from patients with C. difficile-associated diarrhea to metronidazole, vancomycin, rifampicin, fusidic acid, doxycycline, and linezolid were determined by the disc diffusion and Etest (Biodisk, Solna, Sweden). Random amplification of polymorphic DNA-PCR amplification assay was performed for studying clonality of isolates. Resistance to metronidazole was found in 2% (1/49 isolates; MIC > or = 256 microg/mL) of isolates and resistance to linezolid in 2% (1/49 isolates; MIC = 24 microg/mL). One isolate showed combined resistance to fusidic acid (by disc diffusion test) and rifampicin (MIC > or = 32 microg/mL). All isolates were sensitive to doxycycline and vancomycin. Molecular typing revealed an absence of clonality among the resistant isolates, whereas the sensitive isolates were monoclonal. Resistance of C. difficile to metronidazole and other antimicrobials including linezolid exists in our institution. This finding should promote exploration of this problem in Israel and clarify the impact of resistance on outcome.
Collapse
Affiliation(s)
- Jihad Bishara
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Campus, Petah Tiqva 49100, Israel.
| | | | | | | | | |
Collapse
|
28
|
Modena S, Gollamudi S, Friedenberg F. Continuation of antibiotics is associated with failure of metronidazole for Clostridium difficile-associated diarrhea. J Clin Gastroenterol 2006; 40:49-54. [PMID: 16340634 DOI: 10.1097/01.mcg.0000190761.80615.0f] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Metronidazole is first-line therapy for C. difficile-associated diarrhea primarily because of its low cost relative to vancomycin. Currently, it is unknown which patients will fail metronidazole therapy. Our goal was to prospectively evaluate risk factors for metronidazole failure. STUDY Included patients had symptomatic C. difficile-associated diarrhea, either mild or severe. Once enrolled, detailed baseline data were gathered. All interviews were performed daily while the patient was in the hospital for up to 14 days. If discharged prior to 14 days, the patient received a follow-up phone call on day 5 and day 14. Enrolled patients were given a daily stool survey to complete. RESULTS We enrolled 27 patients with C. difficile-associated diarrhea. All patients (10 of 10) who had their offending antibiotic(s) discontinued had symptomatic resolution of diarrhea by day 14 of metronidazole treatment. Conversely, 59% (10 of 17) of patients who remained on antibiotics during treatment had symptomatic resolution by day 14 (P=0.02). The risk ratio for treatment failure was 2.0 (95% confidence interval, 1.29-3.10) in patients who remained on antibiotics. In our treatment group, there would be one additional metronidazole treatment success for every 2.4 patients who discontinued antibiotics. CONCLUSION Patients who remain on antibiotics while undergoing treatment of C. difficile-associated diarrhea have a high likelihood of treatment failure with metronidazole.
Collapse
Affiliation(s)
- Scott Modena
- Section of Gastroenterology, Temple University Hospital, Philadelphia, PA 19140, USA
| | | | | |
Collapse
|
29
|
Arrich J, Sodeck GH, Sengolge G, Konnaris C, Mullner M, Laggner AN, Domanovits H. Clostridium difficile causing acute renal failure: Case presentation and review. World J Gastroenterol 2005; 11:1245-7. [PMID: 15754415 PMCID: PMC4250724 DOI: 10.3748/wjg.v11.i8.1245] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: Clostridium difficile infection is primarily a nosocomial infection but asymptomatic carriers of Clostridium difficile can be found in up to 5% of the general population. Ampicillin, cephalosporins and clindamycin are the antibiotics that are most frequently associated with Clostridium difficile-associated diarrhea or colitis. Little is known about acute renal failure as a consequence of Clostridium difficile-associated diarrhea.
METHODS: In this case report, we describe the course of Clostridium difficile-associated diarrhea in an 82-year-old patient developing acute renal failure. Stopping the offending agent and symptomatic therapy brought a rapid improvement of diarrhea and acute renal failure, full recovery was gained 18 d after admission. In a systematic review we looked for links between the two conditions.
RESULTS: The link between Clostridium difficile-associated diarrhea and acute renal failure in our patient was most likely volume depletion. However, in experimental studies a direct influence of Clostridium difficile toxins on renal duct cells could be shown.
CONCLUSION: Rapid diagnosis, nonspecific supportive treatment and specific antibiotic treatment, especially in the elderly, may lower excess mortality Clostridium difficile-associated diarrhea and renal failure being possible complications.
Collapse
Affiliation(s)
- Jasmin Arrich
- Department of Emergency Medicine, Medical University Vienna, General Hospital, Wahringer Gurtel 18-20, A-1090, Austria
| | | | | | | | | | | | | |
Collapse
|
30
|
Miner J, Gillan MM, Alex P, Centola M. Steroid-refractory ulcerative colitis treated with corticosteroids, metronidazole and vancomycin: a case report. BMC Gastroenterol 2005; 5:3. [PMID: 15667650 PMCID: PMC548304 DOI: 10.1186/1471-230x-5-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2004] [Accepted: 01/24/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increasing evidence elucidating the pathogenic mechanisms of ulcerative colitis (UC) has accumulated and the disease is widely assumed to be the consequence of genetic susceptibility and an abnormal immune response to commensal bacteria. However evidence regarding an infectious etiology in UC remains elusive. CASE PRESENTATION We report a provocative case of UC with profound rheumatologic involvement directly preceded by Clostridium difficile infection and accompanying fever, vomiting, bloody diarrhea, and arthritis. Colonic biopsy revealed a histopathology suggestive of UC. Antibiotic treatment eliminated detectable levels of enteric pathogens but did not abate symptoms. Resolution of symptoms was procurable with oral prednisone, but tapering of corticosteroids was only achievable in combination therapy with vancomycin and metronidazole. CONCLUSIONS An infectious pathogen may have both precipitated and exacerbated autoimmune disease attributes in UC, symptoms of which could be resolved only with a combination of corticosteroids, vancomycin and metronidazole. This may warrant the need for more perceptive scrutiny of C. difficile and the like in patients with UC.
Collapse
Affiliation(s)
- Jonathan Miner
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104 USA
- Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104 USA
| | - M Monem Gillan
- Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104 USA
| | - Philip Alex
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104 USA
- Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104 USA
| | - Michael Centola
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104 USA
- Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104 USA
| |
Collapse
|
31
|
Hecht DW. Prevalence of antibiotic resistance in anaerobic bacteria: worrisome developments. Clin Infect Dis 2004; 39:92-7. [PMID: 15206059 DOI: 10.1086/421558] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2003] [Accepted: 02/07/2004] [Indexed: 11/03/2022] Open
Abstract
Antibiotic-resistant anaerobic bacteria have become increasingly recognized as a confounding factor in the selection of therapeutic agents. The use of potent, broad-spectrum antibiotics as empirical therapy, along with appropriate adjunctive measures, has, in some ways, masked the magnitude of the antibiotic resistance problem that parallels that observed for nonanaerobic pathogens. The use of standardized testing methods that recognize resistance and an understanding of resistance mechanisms have become essential for the treatment of patients and the development of new agents.
Collapse
|
32
|
Fernandez A, Anand G, Friedenberg F. Factors associated with failure of metronidazole in Clostridium difficile-associated disease. J Clin Gastroenterol 2004; 38:414-8. [PMID: 15100520 DOI: 10.1097/00004836-200405000-00005] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
GOAL To identify patients likely to fail metronidazole as initial treatment of C. difficile infection. BACKGROUND For moderate to severe Clostridium difficile-associated diarrhea, metronidazole is the drug of choice for treatment. Oral vancomycin is given to patients who fail metronidazole or have intolerable side effects. STUDY Retrospective review identified all patients treated for C. difficile-associated diarrhea during hospitalization from January 2000 to September 2001. C difficile was documented by a positive toxin assay or pseudomembranes on colonoscopy. Metronidazole failure was defined as persistent symptoms of C. difficile-associated diarrhea after 5 days of uninterrupted therapy. Response was defined as improvement in symptoms at day 5 of therapy including reduction of diarrhea to <or=2 bowel movements per day. RESULTS 119 C. difficile-associated diarrhea patients were identified, and 99 met inclusion criteria. There were 61 (62%) metronidazole responders and 38 (38%) treatment failures. Albumin <2.5g/l and intensive care unit stay at/prior to diagnosis were the only variables associated with treatment failure. The odds ratios for treatment failure were 11.7 (95% confidence interval: 4.0-31.6) and 4.1 (95% confidence interval: 1.3-12.2), respectively. When considering these 2 variables together (low albumin, intensive care unit care), the area under the receiver operating characteristic curve was 0.80 for predicting treatment failure. CONCLUSIONS Albumin level <2.5g/l and intensive care unit stay were predictors of failure of metronidazole therapy for C. difficile-associated diarrhea. These patients may benefit from oral vancomycin therapy at outset.
Collapse
Affiliation(s)
- Angel Fernandez
- Section of Gastroenterology, Temple University Hospital, Philadelphia, PA 19140, USA
| | | | | |
Collapse
|