Antimicrobial susceptibility of Clostridioides difficile isolated from diarrhoeal stool specimens of Canadian patients: summary of results from the Canadian Clostridioides difficile (CAN-DIFF) surveillance study from 2013 to 2017.

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  • Additional Information
    • Affiliation:
      Max Rady College of Medicine, University of Manitoba , Winnipeg, Manitoba, Canada
      Shared Health Manitoba , Winnipeg, Manitoba, Canada
      National Microbiology Laboratory – Public Health Agency of Canada , Winnipeg, Manitoba, Canada
    • Abstract:
      Objectives: To summarize data generated by the Canadian Clostridioides difficile (CAN-DIFF) surveillance study from 2013 to 2017.Methods: Isolates of C. difficile (n = 2158) were cultured from toxin-positive diarrhoeal stool specimens submitted by eight hospital laboratories to a coordinating laboratory. Antimicrobial susceptibility testing was performed according to the CLSI agar dilution method (M11, 2018). Isolate ribotypes were determined using an international, standardized, high-resolution capillary gel-based electrophoresis protocol.Results: Of the 2158 isolates of C. difficile, 2133 (98.8%) had vancomycin MICs ≤2 mg/L [i.e. were vancomycin susceptible (EUCAST breakpoint tables, v 9.0, 2019) or WT (CLSI M100, 29th edition, 2019)]. Fidaxomicin MICs were lower than those of all other agents tested (MIC90, 0.5 mg/L); however, one isolate with a fidaxomicin MIC of >8 mg/L was identified. Metronidazole MICs ranged from 0.12 to 4 mg/L; all isolates were metronidazole susceptible by the CLSI breakpoint (≤8 mg/L) compared with 96.8% susceptible by the EUCAST breakpoint (≤2 mg/L). In total, 182 different ribotypes were identified from 2013 to 2017. The most common ribotypes identified were 027 (19.3% of isolates) and 106 (8.2%). Ribotype 027 isolates were frequently moxifloxacin resistant (87.3% of isolates) and MDR (48.6%), associated with vancomycin (10/25, 40.0%) and metronidazole (58/69, 84.1%) resistance and from patients aged ≥80 years. The prevalence of ribotype 027 decreased significantly (P < 0.0001) from 2013 (27.5%) to 2017 (9.0%) and was replaced by increases in ribotype 106 (P = 0.0003) and multiple less common ribotypes.Conclusions: Periodic surveillance is required to monitor clinical isolates of C. difficile for changes to in vitro susceptibility testing profiles and ribotype evolution.
    • Journal Subset:
      Biomedical; USA
    • ISSN:
      0305-7453
    • MEDLINE Info:
      PMID: NLM32294172 NLM UID: 7513617
    • Publication Date:
      In Process
    • Publication Date:
      20200630
    • DOI:
      http://dx.doi.org/10.1093/jac/dkaa118
    • Accession Number:
      144245014
  • Citations
    • ABNT:
      KARLOWSKY, J. A. et al. Antimicrobial susceptibility of Clostridioides difficile isolated from diarrhoeal stool specimens of Canadian patients: summary of results from the Canadian Clostridioides difficile (CAN-DIFF) surveillance study from 2013 to 2017. Journal of Antimicrobial Chemotherapy (JAC), [s. l.], v. 75, n. 7, p. 1824–1832, 2020. DOI 10.1093/jac/dkaa118. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=rzh&AN=144245014. Acesso em: 10 ago. 2020.
    • AMA:
      Karlowsky JA, Adam HJ, Baxter MR, et al. Antimicrobial susceptibility of Clostridioides difficile isolated from diarrhoeal stool specimens of Canadian patients: summary of results from the Canadian Clostridioides difficile (CAN-DIFF) surveillance study from 2013 to 2017. Journal of Antimicrobial Chemotherapy (JAC). 2020;75(7):1824-1832. doi:10.1093/jac/dkaa118
    • APA:
      Karlowsky, J. A., Adam, H. J., Baxter, M. R., Dutka, C. W., Nichol, K. A., Laing, N. M., Golding, G. R., & Zhanel, G. G. (2020). Antimicrobial susceptibility of Clostridioides difficile isolated from diarrhoeal stool specimens of Canadian patients: summary of results from the Canadian Clostridioides difficile (CAN-DIFF) surveillance study from 2013 to 2017. Journal of Antimicrobial Chemotherapy (JAC), 75(7), 1824–1832. https://doi.org/10.1093/jac/dkaa118
    • Chicago/Turabian: Author-Date:
      Karlowsky, James A, Heather J Adam, Melanie R Baxter, Christopher W Dutka, Kim A Nichol, Nancy M Laing, George R Golding, and George G Zhanel. 2020. “Antimicrobial Susceptibility of Clostridioides Difficile Isolated from Diarrhoeal Stool Specimens of Canadian Patients: Summary of Results from the Canadian Clostridioides Difficile (CAN-DIFF) Surveillance Study from 2013 to 2017.” Journal of Antimicrobial Chemotherapy (JAC) 75 (7): 1824–32. doi:10.1093/jac/dkaa118.
    • Harvard:
      Karlowsky, J. A. et al. (2020) ‘Antimicrobial susceptibility of Clostridioides difficile isolated from diarrhoeal stool specimens of Canadian patients: summary of results from the Canadian Clostridioides difficile (CAN-DIFF) surveillance study from 2013 to 2017’, Journal of Antimicrobial Chemotherapy (JAC), 75(7), pp. 1824–1832. doi: 10.1093/jac/dkaa118.
    • Harvard: Australian:
      Karlowsky, JA, Adam, HJ, Baxter, MR, Dutka, CW, Nichol, KA, Laing, NM, Golding, GR & Zhanel, GG 2020, ‘Antimicrobial susceptibility of Clostridioides difficile isolated from diarrhoeal stool specimens of Canadian patients: summary of results from the Canadian Clostridioides difficile (CAN-DIFF) surveillance study from 2013 to 2017’, Journal of Antimicrobial Chemotherapy (JAC), vol. 75, no. 7, pp. 1824–1832, viewed 10 August 2020, .
    • MLA:
      Karlowsky, James A., et al. “Antimicrobial Susceptibility of Clostridioides Difficile Isolated from Diarrhoeal Stool Specimens of Canadian Patients: Summary of Results from the Canadian Clostridioides Difficile (CAN-DIFF) Surveillance Study from 2013 to 2017.” Journal of Antimicrobial Chemotherapy (JAC), vol. 75, no. 7, July 2020, pp. 1824–1832. EBSCOhost, doi:10.1093/jac/dkaa118.
    • Chicago/Turabian: Humanities:
      Karlowsky, James A, Heather J Adam, Melanie R Baxter, Christopher W Dutka, Kim A Nichol, Nancy M Laing, George R Golding, and George G Zhanel. “Antimicrobial Susceptibility of Clostridioides Difficile Isolated from Diarrhoeal Stool Specimens of Canadian Patients: Summary of Results from the Canadian Clostridioides Difficile (CAN-DIFF) Surveillance Study from 2013 to 2017.” Journal of Antimicrobial Chemotherapy (JAC) 75, no. 7 (July 2020): 1824–32. doi:10.1093/jac/dkaa118.
    • Vancouver/ICMJE:
      Karlowsky JA, Adam HJ, Baxter MR, Dutka CW, Nichol KA, Laing NM, et al. Antimicrobial susceptibility of Clostridioides difficile isolated from diarrhoeal stool specimens of Canadian patients: summary of results from the Canadian Clostridioides difficile (CAN-DIFF) surveillance study from 2013 to 2017. Journal of Antimicrobial Chemotherapy (JAC) [Internet]. 2020 Jul [cited 2020 Aug 10];75(7):1824–32. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=rzh&AN=144245014