TY - JOUR
T1 - Increasing antibiotic resistance in Clostridioides difficile
T2 - A systematic review and meta-analysis
AU - Saha, Srishti
AU - Kapoor, Saloni
AU - Tariq, Raseen
AU - Schuetz, Audrey N.
AU - Tosh, Pritish K.
AU - Pardi, Darrell S.
AU - Khanna, S.
N1 - Publisher Copyright:
© 2019 Elsevier Ltd
PY - 2019/8
Y1 - 2019/8
N2 - Background: Decreases in clinical response of Clostridioides difficile to antibiotics used for its treatment have raised concerns regarding antibiotic resistance. We conducted a systematic review and meta-analysis to study the resistance rates of C. difficile to various antibiotics over time. Methods: We systematically searched MEDLINE, Embase, and Web of Science from inception through 03/31/2017 for observational studies assessing antibiotic resistance rates in C. difficile. Weighted summary estimates were calculated using inverse variance heterogeneity models [MetaXL software (v. 5.3)]. A priori subgroup analyses were done (by study year, continent, susceptibility testing method, origin of isolates); ribotype 027 strains were analyzed separately. Results: From 1982 to 2017, 60 studies (8336 isolates) were analyzed. Fifty-three studies reported vancomycin resistance; weighted pooled resistance (WPR), 2.1% (95% CI, 0%–5.1%; I2 = 95%). Fifty-five studies reported metronidazole resistance; WPR, 1.9% (95% CI, 0.5%–3.6%; I2 = 89%). Compared to the period before 2012, vancomycin resistance increased by 3.6% (95% CI, 2.9%–4.2%; P < 0.001) after 2012, and metronidazole resistance decreased by 0.8% (95% CI, 0.1%–1.5%; P = 0.02). No isolates were resistant to fidaxomicin. Conclusion: Resistance of C. difficile to vancomycin is increasing, with a smaller, declining resistance to metronidazole; there is significant heterogeneity between studies. Ongoing monitoring of resistance to commonly used antibiotics is required.
AB - Background: Decreases in clinical response of Clostridioides difficile to antibiotics used for its treatment have raised concerns regarding antibiotic resistance. We conducted a systematic review and meta-analysis to study the resistance rates of C. difficile to various antibiotics over time. Methods: We systematically searched MEDLINE, Embase, and Web of Science from inception through 03/31/2017 for observational studies assessing antibiotic resistance rates in C. difficile. Weighted summary estimates were calculated using inverse variance heterogeneity models [MetaXL software (v. 5.3)]. A priori subgroup analyses were done (by study year, continent, susceptibility testing method, origin of isolates); ribotype 027 strains were analyzed separately. Results: From 1982 to 2017, 60 studies (8336 isolates) were analyzed. Fifty-three studies reported vancomycin resistance; weighted pooled resistance (WPR), 2.1% (95% CI, 0%–5.1%; I2 = 95%). Fifty-five studies reported metronidazole resistance; WPR, 1.9% (95% CI, 0.5%–3.6%; I2 = 89%). Compared to the period before 2012, vancomycin resistance increased by 3.6% (95% CI, 2.9%–4.2%; P < 0.001) after 2012, and metronidazole resistance decreased by 0.8% (95% CI, 0.1%–1.5%; P = 0.02). No isolates were resistant to fidaxomicin. Conclusion: Resistance of C. difficile to vancomycin is increasing, with a smaller, declining resistance to metronidazole; there is significant heterogeneity between studies. Ongoing monitoring of resistance to commonly used antibiotics is required.
KW - Antibiotic
KW - Antimicrobial
KW - Clostridioides difficile infection
KW - Resistance
KW - Susceptibility
UR - http://www.scopus.com/inward/record.url?scp=85069732547&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85069732547&partnerID=8YFLogxK
U2 - 10.1016/j.anaerobe.2019.102072
DO - 10.1016/j.anaerobe.2019.102072
M3 - Article
C2 - 31330183
AN - SCOPUS:85069732547
SN - 1075-9964
VL - 58
SP - 35
EP - 46
JO - Anaerobe
JF - Anaerobe
ER -