Drummond, L. J., McCoubrey, J., Smith, D. G.E., Starr, J. M. and Poxton, I. R. (2003) Changes in sensitivity patterns to selected antibiotics in Clostridium difficile in geriatric in-patients over an 18-month period. Journal of Medical Microbiology, 52(3), pp. 259-263. (doi: 10.1099/jmm.0.05037-0)
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Publisher's URL: http://dx.doi.org/10.1099/jmm.0.05037-0
Abstract
<i>Clostridium difficile</i> -associated disease continues to be a major problem in hospitals and long-term care facilities throughout the developed world. Administration of certain antibiotics such as amoxycillin, oral cephalosporins and clindamycin is associated with the greatest risk of developing <i>C. difficile</i> disease. The two antibiotics used for treatment of <i>C. difficile</i> disease are vancomycin and metronidazole, to which there is currently very little resistance. Randomly selected isolates (186) from 90 patients being investigated during an 18-month epidemiological study into the disease were tested for their susceptibility to vancomycin, metronidazole, amoxycillin, clindamycin, cefoxitin and ceftriaxone by the NCCLS agar dilution method. There was a narrow range of MIC for the two treatment agents (vancomycin and metronidazole), from 0.5 to 4 μg ml<sup>−1</sup>, with no evidence of resistance. All strains were resistant to cefoxitin (MIC 64–256 μg ml<sup>−1</sup>), the antibiotic used in most selective media. All strains were of similar sensitivity to amoxycillin (MIC<sub>90</sub>= 4 μg ml<sup>−1</sup>). Most strains were resistant to ceftriaxone (MIC ≥ 64 μg ml<sup>−1</sup>) or of intermediate resistance (MIC ≥ 32 μg ml<sup>−1</sup>), with only two sensitive strains (MIC 16 μg ml<sup>−1</sup>). Clindamycin resistance was common, with 67 % of strains resistant (MIC ≥ 8 μg ml<sup>−1</sup>), 25 % with intermediate resistance (MIC ≥ 4 μg ml<sup>−1</sup>) and only 8 % sensitive (MIC ≤ 2 μg ml<sup>−1</sup>). Twelve isolates from six different patients had very high resistance to clindamycin (MIC ≥ 128 μg ml<sup>−1</sup>). Multiple isolates from the same patient, taken at different times, showed changes in susceptibility patterns over time. The only major change in susceptibility over the time-period was in clindamycin resistance; some strains appeared to become more resistant while others became less resistant. No differences were seen in the MIC<sub>50</sub> and MIC<sub>90</sub> of the different S-types of <i>C. difficile</i> identified, although some S-types were present in very small numbers. There was no correlation between the antibiotics prescribed and susceptibility.
Item Type: | Articles |
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Status: | Published |
Refereed: | Yes |
Glasgow Author(s) Enlighten ID: | Smith, Professor David |
Authors: | Drummond, L. J., McCoubrey, J., Smith, D. G.E., Starr, J. M., and Poxton, I. R. |
College/School: | College of Medical Veterinary and Life Sciences > School of Infection & Immunity |
Journal Name: | Journal of Medical Microbiology |
Publisher: | Society for General Microbiology |
ISSN: | 0022-2615 |
ISSN (Online): | 1473-5644 |
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