Jeffrey T Wieczorkiewicz, Andrew M Skinner, Adam Cheknis, Laurica A Petrella, Vanessa W Stevens, Lorinda M Wright, Dale N Gerding, Stuart Johnson
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Multivariable analysis revealed that BI cases were 2.47 times more likely to be associated with fluoroquinolone exposure compared to non-BI cases (95% confidence interval [CI]: 1.12-5.46). In addition, the odds of developing a CDI after third- or fourth-generation cephalosporin exposure was 2.83 times for DH cases than for non-DH cases (95% CI: 1.06-7.54). Fluoroquinolone use in the hospital decreased from 2005 to 2015 from a peak of 113 to a low of 56 antimicrobial days/1,000 patient days. In contrast, cephalosporin use increased from 42 to 81 antimicrobial days/1,000 patient days. These changes correlated with a decrease in geometric mean MIC for ciprofloxacin (61.03 to 42.65 mg/L, <i>P</i> = 0.02) and an increase in geometric mean MIC for ceftriaxone (40.87 to 86.14 mg/L, <i>P</i> < 0.01) among BI isolates. The BI strain remained resistant to fluoroquinolones, but an overall decrease in fluoroquinolone use and increase in cephalosporin use were associated with a decrease in the prevalence of BI, an increased diversity of <i>C. difficile</i> strain types, and the emergence of strains DH and Y.</p>","PeriodicalId":8152,"journal":{"name":"Antimicrobial Agents and Chemotherapy","volume":null,"pages":null},"PeriodicalIF":4.1000,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11304679/pdf/","citationCount":"0","resultStr":"{\"title\":\"Epidemiology of <i>Clostridioides difficile</i> infection at one hospital 10 years after an outbreak of the epidemic <i>C. difficile</i> strain BI/027: changing strain prevalence, antimicrobial susceptibilities, and patient antibiotic exposures.\",\"authors\":\"Jeffrey T Wieczorkiewicz, Andrew M Skinner, Adam Cheknis, Laurica A Petrella, Vanessa W Stevens, Lorinda M Wright, Dale N Gerding, Stuart Johnson\",\"doi\":\"10.1128/aac.00698-24\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>In contrast to the epidemiology 10 years earlier at our hospital when the epidemic restriction endonuclease analysis (REA) group strain BI accounted for 72% of <i>Clostridioides difficile</i> isolates recovered from first-episode <i>C. difficile</i> infection (CDI) cases, BI represented 19% of first-episode CDI isolates in 2013-2015. Two additional REA group strains accounted for 31% of isolates (Y, 16%; DH, 12%). High-level resistance to fluoroquinolones and azithromycin was more common among BI isolates than among DH, Y, and non-BI/DH/Y isolates. Multivariable analysis revealed that BI cases were 2.47 times more likely to be associated with fluoroquinolone exposure compared to non-BI cases (95% confidence interval [CI]: 1.12-5.46). In addition, the odds of developing a CDI after third- or fourth-generation cephalosporin exposure was 2.83 times for DH cases than for non-DH cases (95% CI: 1.06-7.54). Fluoroquinolone use in the hospital decreased from 2005 to 2015 from a peak of 113 to a low of 56 antimicrobial days/1,000 patient days. In contrast, cephalosporin use increased from 42 to 81 antimicrobial days/1,000 patient days. These changes correlated with a decrease in geometric mean MIC for ciprofloxacin (61.03 to 42.65 mg/L, <i>P</i> = 0.02) and an increase in geometric mean MIC for ceftriaxone (40.87 to 86.14 mg/L, <i>P</i> < 0.01) among BI isolates. 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引用次数: 0
摘要
10年前,本医院流行的限制性内切酶分析(REA)组菌株BI占从首次发病的艰难梭菌感染(CDI)病例中分离出的艰难梭菌的72%,而2013-2015年,BI占首次发病的艰难梭菌感染分离株的19%。另外两种 REA 组菌株占分离株的 31%(Y,16%;DH,12%)。与DH、Y和非BI/DH/Y分离株相比,BI分离株对氟喹诺酮类药物和阿奇霉素的高水平耐药性更为常见。多变量分析显示,与非 BI 病例相比,BI 病例接触氟喹诺酮类药物的几率是后者的 2.47 倍(95% 置信区间 [CI]:1.12-5.46)。此外,与非 DH 病例相比,DH 病例在接触第三代或第四代头孢菌素后患 CDI 的几率是后者的 2.83 倍(95% 置信区间 [CI]:1.06-7.54)。从 2005 年到 2015 年,医院中氟喹诺酮类药物的使用量从高峰期的 113 天减少到最低的 56 天/1,000 个患者日。相比之下,头孢菌素的使用量从 42 个抗菌药物日/1,000 个患者日增加到 81 个抗菌药物日/1,000 个患者日。这些变化与 BI 分离物中环丙沙星的几何平均 MIC 值下降(61.03 至 42.65 mg/L,P = 0.02)和头孢曲松的几何平均 MIC 值上升(40.87 至 86.14 mg/L,P < 0.01)相关。BI 菌株仍对氟喹诺酮类药物耐药,但氟喹诺酮类药物使用的总体减少和头孢菌素使用的增加与 BI 感染率的下降、艰难梭菌菌株类型多样性的增加以及 DH 和 Y 菌株的出现有关。
Epidemiology of Clostridioides difficile infection at one hospital 10 years after an outbreak of the epidemic C. difficile strain BI/027: changing strain prevalence, antimicrobial susceptibilities, and patient antibiotic exposures.
In contrast to the epidemiology 10 years earlier at our hospital when the epidemic restriction endonuclease analysis (REA) group strain BI accounted for 72% of Clostridioides difficile isolates recovered from first-episode C. difficile infection (CDI) cases, BI represented 19% of first-episode CDI isolates in 2013-2015. Two additional REA group strains accounted for 31% of isolates (Y, 16%; DH, 12%). High-level resistance to fluoroquinolones and azithromycin was more common among BI isolates than among DH, Y, and non-BI/DH/Y isolates. Multivariable analysis revealed that BI cases were 2.47 times more likely to be associated with fluoroquinolone exposure compared to non-BI cases (95% confidence interval [CI]: 1.12-5.46). In addition, the odds of developing a CDI after third- or fourth-generation cephalosporin exposure was 2.83 times for DH cases than for non-DH cases (95% CI: 1.06-7.54). Fluoroquinolone use in the hospital decreased from 2005 to 2015 from a peak of 113 to a low of 56 antimicrobial days/1,000 patient days. In contrast, cephalosporin use increased from 42 to 81 antimicrobial days/1,000 patient days. These changes correlated with a decrease in geometric mean MIC for ciprofloxacin (61.03 to 42.65 mg/L, P = 0.02) and an increase in geometric mean MIC for ceftriaxone (40.87 to 86.14 mg/L, P < 0.01) among BI isolates. The BI strain remained resistant to fluoroquinolones, but an overall decrease in fluoroquinolone use and increase in cephalosporin use were associated with a decrease in the prevalence of BI, an increased diversity of C. difficile strain types, and the emergence of strains DH and Y.
期刊介绍:
Antimicrobial Agents and Chemotherapy (AAC) features interdisciplinary studies that build our understanding of the underlying mechanisms and therapeutic applications of antimicrobial and antiparasitic agents and chemotherapy.