<i>Clostridioides difficile</i> resistance to antibiotics, including post-COVID-19 data
Creators: name: Boyanova, Lyudmila
name: Dimitrov, Georgi
name: Gergova, Raina
name: Hadzhiyski, Petyo
name: Markovska, Rumyana
Publisher: name: Taylor & Francis
Year: 2023
Subjects: subject: Space Science
subject: Medicine
subject: Microbiology
subject: FOS: Biological sciences
subject: Pharmacology
subject: Biotechnology
subject: Environmental Sciences not elsewhere classified
subject: Chemical Sciences not elsewhere classified
subject: Ecology
subject: Cancer
subject: Hematology
subject: Infectious Diseases
subject: FOS: Health sciences
subject: Virology

description: Updating data on <i>Clostridioides difficile</i> antibiotic resistance is important for treatment improvement of <i>C. difficile</i> infections (CDIs). Results from 20 countries were included. The mean resistance to 2 mg/l vancomycin, 2 mg/l metronidazole, 4 mg/l moxifloxacin, and 4 mg/l clindamycin was 4.7% (0 to ≥ 26% in two studies), 2.6% (0 to ≥ 40% in 3 studies), 34.9% (6.6-&gt;80%), and 61.0% (30-&gt;90%), respectively. Resistance to erythromycin (&gt;60–88%), rifampin (&gt;23–55.0%), imipenem (0.6 to &gt; 78% in a clone), tigecycline (0-&lt;5.0%), and fidaxomicin (0–2%) was also found. Resistance to ≥ 5 antibiotics of different classes was reported in some countries. High resistance and multidrug resistance were observed in hypervirulent and epidemic strains. Although only 1% of COVID-19 patients had CDIs, the proportion might be underestimated. <i>C. difficile</i> antimicrobial susceptibility varied by country/region, study period, and circulating ribotypes. For CDI treatment, fidaxomicin (preferably) or vancomycin is recommended, while metronidazole is suitable for mild infections. New approaches, including biotherapeutics (Rebyota), strains, antibiotics (ridinilazole and ibezapolstat), and monoclonal antibodies/cocktails merit further evaluation. Because of the resistance rate variations, <i>C. difficile</i> antibiotic susceptibility should be regularly monitored. Post-COVID-19 resistance should be separately presented. Some discrepancies between vancomycin and metronidazole results need to be clarified. <i>Clostridioides difficile</i> can cause mild to dangerous diarrhea in people following antibiotic use. Many antibacterial agents can cause diseases. However, treatment is limited to three antibiotics. The study of resistance to them is important for improving the treatment of infections. The study of resistance to other antibiotics helps to understand the spread and risks of infections. We discussed data about <i>C. difficile</i> antibiotic resistance from 20 countries according to recent publications. For the treatment of <i>C. difficile</i>infections, fidaxomicin is the drug of choice with 0–2% resistance to it. Resistance to the two other antibiotics used to treat infections is less than 5% of isolates. Much higher resistance was found to antibiotics that can cause <i>C. difficile</i> infections such as ciprofloxacin, clindamycin, ceftriaxone, erythromycin, and others. The resistance varies according to the country, patients’ groups, years of study, and circulating strains. The resistance was high in hypervirulent and epidemic strains. In some studies, there was resistance to 5 and 6 antibiotics of different classes. Antibiotic use and incidence of infections during the COVID-19 pandemic varied. However, the evolution of <i>C. difficile</i> infection during the pandemic has yet to be determined.