Article Figures & Data
Figures
- Figure 1
- Worldwide distribution of hypervirulent Clostridioides difficile PCR ribotype (RT) 027.
Tables
- Table 1
- Mechanism of action and resistance of different antimicrobials and resistance rates against Clostridioides difficile.
Antimicrobials Targets Putative resistance mechanism (S) Resistances (%) Refrences Metronidazole Bacterial DNA Alterations in some metabolic pathways, biofilm formation 0-20.25 32,33,36,41 Vancomycin Binding to D-alanyl-D-alanine residues precursor of peptidoglycan Mutations in peptidoglycan biosynthesis-required proteins, biofilm formation 0-41 32,33,36,41 Rifampicin Bacterial DNA-dependent RNA polymerase Mutations in rpoB 0-91 32,36,41 Clindamycin 50s ribosomal subunit of bacteria Alterations in ribosomal target or active efflux pumps 0-100 26,32,33,36,41 Erythromycin 50s subunit of the bacteria Alterations in ribosomal target or active efflux pumps 0-100 26,32,33,36,41 Tetracycline 30S ribosomal subunit of bacteria Tetracycline resistance protein (tetM) and the active efflux pumps 0-62.7 26,32,33,36,41 Moxifloxacin Bacterial DNA gyrase Alteration of the drug target 0-100 32,33,41 Fusidic acid Blocking the ribosome by binding to “factor G” Mutations in fusA 0-40 41 Ciprofloxacin Bacterial DNA gyrase Alteration of the drug target and the active efflux pumps 23-42 33,41 - Table 2
- Simplified comparison of various laboratory detection methods for the detection of Clostridioides difficile infection.
Techniques Criteria Advantages Limitations References Simple to perform Simple to interpret Specimen type Turnaround time Sensitivity (%) Specificity (%) TC Good Good Stool 2-7 days High Low Due to its high sensitivity, it is recommended as a reference method; it allows performing strain typing and antimicrobial suitability test Long turnaround time; need to be combined with another method 8,18,85 CTA Fair Good Stool filtrate 48-72 hours High High Has acceptable sensitivity and specificity, and it is inexpensive Labor-intensive, long turnaround time, and lack of harmonization 18,85,86 EIA for detecting GDH Good Good Stool Rapid 2-6 hours Low Low Quick to produce results, and simple to use Lacks specificity, high false-positive rate, and should be used in combination with another method 8,18,85,87 EIA for detecting toxins A or B Good Good Stool Rapid 2-6 hours Low Moderate Quick to produce results, and simple to use Insensitive enough in the detection of toxin-producing isolates of C. difficile in comparison to other techniques such as TC or CTA. High false-negative rate 8,18,85,87 NAAT Good Good Stool Rapid 2 hours High Low/moderate Rapid and highly sensitive Identify carriers of toxigenic C. difficile who have no symptoms. Genetic variation in tcdB or tcdA genes might lead to false-negative results. Expensive 8,85,87,90 TC: toxigenic culture, CTA: cell cytotoxicity assay, GDH: glutamate dehydrogenase, NAAT: nucleic acid amplification test, EIA: enzyme immunoassay
