Mechanisms and impact of antimicrobial resistance in Clostridioides difficile

•Plasmid mediated resistances to metronidazole (pCD-METRO) and vancomycin (pX18-498) may reduce their efficacies.•Heme-dependent resistance to metronidazole found in most metronidazole-resistant C. difficile may promote clinical failure.•Resistance to autolysis and the ‘Eagle effect’ could mediate s...

Full description

Saved in:
Bibliographic Details
Published in:Current opinion in microbiology 2022-04, Vol.66, p.63-72
Main Authors: Dureja, Chetna, Olaitan, Abiola O, Hurdle, Julian G
Format: Article
Language:English
Subjects:
Anti-Bacterial Agents - pharmacology
Anti-Bacterial Agents - therapeutic use
Anti-Infective Agents
Clostridioides
Clostridioides difficile - genetics
Clostridium Infections - drug therapy
Drug Resistance, Bacterial - genetics
Humans
Microbial Sensitivity Tests
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:•Plasmid mediated resistances to metronidazole (pCD-METRO) and vancomycin (pX18-498) may reduce their efficacies.•Heme-dependent resistance to metronidazole found in most metronidazole-resistant C. difficile may promote clinical failure.•Resistance to autolysis and the ‘Eagle effect’ could mediate survival in physiological vancomycin.•Resistance testing should be a part of the diagnostic work-up for CDI.•Genomic surveillances could track C. difficile evolution to improve antimicrobial stewardship policies. The evolution of antimicrobial resistance in Clostridioides difficile has markedly shaped its epidemiology and detrimentally impacted patient care. C. difficile exhibits resistance to multiple classes of antimicrobials, due to accumulation of horizontally acquired resistance genes and de novo mutations to drug targets. Particularly worrying is that declines in clinical success of firstline CDI antimicrobials coincide with the spread of strains that are more resistant to these drugs. Yet, there is still much to learn regarding the prevalence of genetic elements in clinical isolates, their molecular mechanisms, and the extent to which this information can be translated to develop molecular diagnostics that improve antimicrobial prescribing and antimicrobial stewardship approaches for CDI. Thus, this perspective discusses current understanding and knowledge gaps of antimicrobial resistance mechanisms in C. difficile, emphasizing on CDI therapies.
ISSN:1369-5274
1879-0364
DOI:10.1016/j.mib.2022.01.004