Increasing antibiotic resistance in Clostridioides difficile: A systematic review and meta-analysis

Saha, S. and Kapoor, S. and Tariq, R. and Schuetz, A. N. and Tosh, P. K. and Pardi, D. S. and Khanna, S.

Anaerobe (2019) 58: 35–46

DOI: 10.1016/j.anaerobe.2019.102072

Abstract

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%; I(2) = 95%). Fifty-five studies reported metronidazole resistance; WPR, 1.9% (95% CI, 0.5%-3.6%; I(2) = 89%). Compared to the period before 2012, vancomycin resistance increased by 3.6% (95% CI, 2.9%-4.2%; P \textless 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.

Citation

Saha, S., Kapoor, S., Tariq, R., Schuetz, A. N., Tosh, P. K., Pardi, D. S., & Khanna, S. (2019). Increasing antibiotic resistance in Clostridioides difficile: A systematic review and meta-analysis. Anaerobe, 58, 35–46. https://doi.org/10.1016/j.anaerobe.2019.102072 Animals, Humans, Global Health, Resistance, Prevalence, Antibiotic, Susceptibility, *Drug Resistance, Bacterial, Antimicrobial, Clostridioides difficile infection, Clostridioides difficile/*drug effects/isolation & purification, Clostridium Infections/*epidemiology/*microbiology/veterinary

Keywords

• Animals
• Humans
• Global Health
• Resistance
• Prevalence
• Antibiotic
• Susceptibility
• *Drug Resistance
• Bacterial
• Antimicrobial
• Clostridioides difficile infection
• Clostridioides difficile/*drug effects/isolation & purification
• Clostridium Infections/*epidemiology/*microbiology/veterinary