Abstract
BackgroundClostridium difficile infection (CDI) remains a major health problem worldwide. Antibiotic use, in general, and clindamycin and ciprofloxacin, in particular, have been implicated in the pathogenesis of CDI. Here, we hypothesized that antibiotics that are highly active in vitro against C. difficile are less frequently associated with CDI than others. The primary goals of our study were to determine if antibiotic susceptibility and CDI are associated and whether the antimicrobial susceptibility of C. difficile changed over the years.Methods and resultsWe examined a large panel of C. difficile strains collected in 2006-2008 at the University Hospital of Zurich. We found that the antimicrobial susceptibilities to amoxicillin/clavulanate, piperacillin/tazobactam, meropenem, clindamycin, ciprofloxacin, ceftriaxone, metronidazole and vancomycin were similar to those reported in the literature and that they are similar to those reported in other populations over the last two decades. Antibiotic activity did not prevent CDI. For example, thre use of meropenem, which is highly active against all strains tested, was a clear risk factor for CDI. Most of the antibiotics tested also showed a higher minimum inhibitory concentration distribution than that of EUCAST. All strains were susceptible to metronidazole. One strain was resistant to vancomycin.ConclusionsAntibiotic susceptibilities of the collection of C. difficile from the University Hospital of Zurich are similar to those reported by others since the 1980. Patients treated with carbapenems and cephalosporins had the highest risk of developing CDI irrespective of the antimicrobial activity of carbapenems.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0607-z) contains supplementary material, which is available to authorized users.
Highlights
Clostridium difficile infection (CDI) remains a major health problem worldwide
Antibiotic susceptibilities of the collection of C. difficile from the University Hospital of Zurich are similar to those reported by others since the 1980
Patients treated with carbapenems and cephalosporins had the highest risk of developing CDI irrespective of the antimicrobial activity of carbapenems
Summary
Clostridium difficile infection (CDI) remains a major health problem worldwide. We hypothesized that antibiotics that are highly active in vitro against C. difficile are less frequently associated with CDI than others. Antibiotic-associated pseudomembranous colitis due to toxin-producing clostridia was first recognized by Bartlett et al [1]. Today this manifestation is best known as Clostridium difficile infection (CDI). The clinical manifestations of CDI include mild-to-profuse diarrhea with abdominal pain and, in the most severe form, toxic megacolon and perforation. The latter presentation has a mortality rate of 25–40% [5]. The overall mortality rate of CDI increased significantly since 2000 to approximately 6%
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