Reference Susceptibility Testing and Genomic Surveillance of Clostridioides difficile, United States, 2012–17
Author:
Gargis Amy S1ORCID, Karlsson Maria12ORCID, Paulick Ashley L1ORCID, Anderson Karen F1, Adamczyk Michelle1, Vlachos Nicholas1, Kent Alyssa G1ORCID, McAllister Gillian1, McKay Susannah L1, Halpin Alison L1ORCID, Albrecht Valerie1, Campbell Davina1, Korhonen Lauren C1, Elkins Christopher A1ORCID, Rasheed J Kamile1, Guh Alice Y1, McDonald L Clifford1ORCID, Lutgring Joseph D1ORCID, Dumyati Ghinwa, Fridkin Scott, Gerding Dale, Holzbauer Stacy M, Johnston Helen, Olson Danyel M, Perlmutter Rebecca, Phipps Erin C, Pierce Rebecca, Wilson Christopher, Winston Lisa,
Affiliation:
1. Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia , USA 2. Goldbelt C6, LLC, Chesapeake, Virginia, USA
Abstract
Abstract
Background
Antimicrobial susceptibility testing (AST) is not routinely performed for Clostridioides difficile and data evaluating minimum inhibitory concentrations (MICs) are limited. We performed AST and whole genome sequencing (WGS) for 593 C. difficile isolates collected between 2012 and 2017 through the Centers for Disease Control and Prevention's Emerging Infections Program.
Methods
MICs to 6 antimicrobial agents (ceftriaxone, clindamycin, meropenem, metronidazole, moxifloxacin, and vancomycin) were determined using the reference agar dilution method according to Clinical and Laboratory Standards Institute guidelines. Whole genome sequencing was performed on all isolates to detect the presence of genes or mutations previously associated with resistance.
Results
Among all isolates, 98.5% displayed a vancomycin MIC ≤2 μg/mL and 97.3% displayed a metronidazole MIC ≤2 μg/mL. Ribotype 027 (RT027) isolates displayed higher vancomycin MICs (MIC50: 2 μg/mL; MIC90: 2 μg/mL) than non-RT027 isolates (MIC50: 0.5 μg/mL; MIC90: 1 μg/mL) (P < .01). No vanA/B genes were detected. RT027 isolates also showed higher MICs to clindamycin and moxifloxacin and were more likely to harbor associated resistance genes or mutations.
Conclusions
Elevated MICs to antibiotics used for treatment of C. difficile infection were rare, and there was no increase in MICs over time. The lack of vanA/B genes or mutations consistently associated with elevated vancomycin MICs suggests there are multifactorial mechanisms of resistance. Ongoing surveillance of C. difficile using reference AST and WGS to monitor MIC trends and the presence of antibiotic resistance mechanisms is essential.
Publisher
Oxford University Press (OUP)
Subject
Infectious Diseases,Microbiology (medical)
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