7 : Clindamycin-Resistant

MyBook is a cheap paperback edition of the original book and will be sold at uniform, low price.

Preview this chapter:
Zoom in

Clindamycin-Resistant , Page 1 of 2

| /docserver/preview/fulltext/10.1128/9781555816988/9781555812164_Chap07-1.gif /docserver/preview/fulltext/10.1128/9781555816988/9781555812164_Chap07-2.gif


In light of subsequent data regarding clindamycin use as a risk factor for disease caused by clindamycin-resistant strains of , it is also tempting to speculate that an outbreak was caused by clindamycin-resistant . Overall, 21% of the 308 isolates were resistant to clindamycin, yet by serogrouping, the researchers were able to show that clindamycin resistance was concentrated in specific groups of strains of . Studies from the United States, Canada, and Europe confirm the widespread presence of clindamycin resistance among isolates during the first 10 years following the discovery that the organism was the cause of pseudomembranous colitis (PMC). The accepted breakpoint for clindamycin resistance based on drug concentrations in serum is an MIC of >4 μg/ml. The current best explanation of this is that the disruption of normal intestinal flora is likely the determining antibiotic event that makes patients susceptible to infection with . The Belgium study was important in showing not only the relationship of clindamycin use and clindamycin resistance but also the possible clonal nature of clindamycin-resistant strains. Although the researchers did not correlate risk of infection with the strain with the use of clindamycin, they did place clindamycin use under restriction and observed in retrospect an associated decline in -associated diarrhea (CDAD) rates, suggesting that clindamycin resistance and clindamycin use were important risk factors in the outbreak.

Citation: Gerding D, Johnson S. 2001. Clindamycin-Resistant , p 111-120. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 5. ASM Press, Washington, DC. doi: 10.1128/9781555816988.ch7

Key Concept Ranking

Clostridium difficile
Highlighted Text: Show | Hide
Loading full text...

Full text loading...


1. Barbut, F.,, D. Decré,, B. Burghoffer,, D. Lesage,, F. Delisle,, V. Lalande,, M. Delmée,, V. Avesani,, N. Sano,, C. Coudert,, and J.-C. Petit. 1999. Antimicrobial susceptibilities and serogroups of clinical strains of Clostridium difficile isolated in France in 1991 and 1997. Antimicrob Agents Chemother. 43:26072611.
2. Bartlett, J. G.,, A. B. Onderdonk,, R. L. Cisneros,, and D. L. Kasper. 1977. Clindamycin-associated colitis due to a toxin-producing species of clostridium in hamsters. J. Infect. Dis. 136:701705.
3. Bignardi, G. E. 1998. Risk factors for Clostridium difficile infection. J. Hosp. Infect. 40:115.
4. Chow, A. W.,, N. Cheng,, and K. H. Bartlett. 1985. In vitro susceptibility of Clostridium difficile to new beta-lactam and quinolone antibiotics. Antimicrob. Agents Chemother. 28:842844.
5. Clabots, C. R.,, C. J. Shanholtzer,, L. R. Peterson,, and D. N. Gerding. 1987. In vitro activity of efrotomycin, ciprofloxacin, and six other antimicrobials against Clostridium difficile. Diagn. Microbiol. Infect. Dis. 6:4952.
6. Clabots, C. R.,, L. R. Peterson,, and D. N. Gerding. 1988. Characterization of a nosocomial Clostridium difficile outbreak by using plasmid profile typing and clindamycin susceptibility testing. J. Infect. Dis. 158:731736.
7. Climo, M. W.,, D. S. Israel,, E. S. Wong,, D. Williams,, P. Coudron,, and S. M. Markowitz. 1998. Hospital-wide restriction of clindamycin: effect on the incidence of Clostridium difficile-associated diarrhea and cost. Ann. Intern. Med. 128:989995.
8. Cohen, L. E.,, C. J. McNeill,, and R. F. Wells. 1973. Clindamycin-associated colitis. JAMA 223: 13791380.
9. Delmee, M.,, and V. Avesani. 1988. Correlation between serogroup and susceptibility to chloramphenicol, clindamycin, erythromycin, rifampicin, and tetracycline among 308 isolates of Clostridium difficile. J. Antimicrob. Chemother. 22:325331.
10.Dzink J., and J. G. Bartlett. 1980. In vitro susceptibility of Clostridium difficile isolates from patients with antibiotic-associated diarrhea or colitis. Antimicrob. Agents Chemother. 17:695698.
11. Farrow, K. A.,, D. Lyras,, and J. I. Rood. 2000. The macrolide-lincosamide-streptogramin B resistance determinant from Clostridium difficile 630 contains two erm(B) genes. Antimicrob. Agents Chemother. 44:411413.
12. Hachler, H.,, B. Berger-Bachi,, and F. H. Kayser. 1987. Genetic characterization of a Clostridium difficile erythromycin-clindamycin resistance determinant that is tranferable to Staphylococcus aureus. Antimicrob. Agents Chemother. 31:10391045.
13. Ionesco, H. 1980. Transferable tetracycline resistance in Clostridium difficile. Ann. Microbiol. 131A:171179.
14. Johnson, S.,, and D. N. Gerding. 1998. Clostridium difficile-associated diarrhea. Clin. Infect. Dis. 26:10271036.
15. Johnson, S.,, M. H. Samore,, K. A. Farrow,, G. E. Killgore,, F. C. Tenover,, D. Lyras,, J. L. Rood,, P. DeGirolami,, A. L. Baltch,, M. E. Rafferty,, S. M. Pear,, and D. N. Gerding. 1999. Epidemics of diarrhea caused by a clindamycin-resistant strain of Clostridium difficile in four hospitals. N. Engl. J. Med. 341:16451651.
16. Kyne, L.,, M. Warny,, A. Qamar,, and C. P. Kelly. 2000. Asymptomatic carriage of Clostridium difficile and serum levels of IgG antibody against toxin A. N. Engl. J. Med. 342:390397.
17. Larson, H. E.,, and S. P. Borriello. 1990. Quantitative study of antibiotic-induced susceptibility to Clostridium difficile enterocecitis in hamsters. Antimicrob. Agents Chemother. 34:13481353.
18. Mullany, P.,, M. Wilks,, and S. Tabaqchali. 1995. Transfer of macrolide-lincosamide-streptogramin B (MLS) resistance in Clostridium difficile is linked to a gene homologous with toxin A and is mediated by a conjugative transposon, Tn5398. J. Antimicrob. Chemother. 35:305315.
19. Nelson, D. E.,, S. B. Auerbach,, A. L. Baltch,, E. Desjardin,, C. Beck-Sague,, C. Rheal,, R. P. Smith,, and W. R. Jarvis. 1994. Epidemic Clostridium difficile-associated diarrea: role of second- and third-generation cephalosporins. Infect. Control Hosp. Epidemiol. 15:8894.
20. Nord, C. E. 1996. In vitro activity of quinolones and other antimicrobial agents against anaerobic bacteria. Clin. Infect. Dis. 23(Suppl. 1):S15S18.
21. Pear, S. M.,, T. H. Williamson,, K. M. Bettin,, D. N. Gerding,, and J. N. Galgiani. 1994. Decrease in nosocomial Clostridium difficile-associated diarrhea by restricting clindamycin use. Ann. Intern. Med. 120:272277.
22. Quale, J.,, D. Landman,, G. Saurina,, E. Atwood,, V. DiTore,, and K. Patel. 1996. Manipulation of a hospital antimicrobial formulary to control an outbreak of vancomycin-resistant enterococci. Clin. Infect. Dis. 23:10201025.
23. Roberts, M. C.,, L. V. McFarland,, P. Mullany,, and M. E. Mulligan. 1994. Characterization of the genetic basis of antibiotic resistance in Clostridium difficile. J. Antimicrob. Chemother. 33:419429.
24. Samore, M.,, G. Killgore,, S. Johnson,, R. Goodman,, J. Shim,, L. Venkataraman,, S. Sambol,, P. DeGirolami,, F. Tenover,, R. Arbeit,, and D. Gerding. 1997. Multicenter typing comparison of sporadic and outbreak Clostridium difficile isolates from geographically diverse hospitals. J. Infect. Dis. 176:12331238.
25. Samore, M. H.,, L. Venkataraman,, P. C. DeGirolami,, R. D. Arbeit,, and A. W. Karchmer. 1996. Clinical and molecular epidemiology of sporadic and clustered cases of nosocomial Clostridium difficile diarrhea. Am. J. Med. 100:3240.
26. Sheikh, W.,, D. H. Pitkin,, and H. Nadler. 1993. Antibacterial activity of meropenem and selected comparative agents against anaerobic bacteria at seven North American centers. Clin. Infect. Dis. 16(Suppl. 4):S361S66.
27. Tedesco, F. J.,, R. W. Barton,, and H. D. Alpers. 1974. Clindamycin-associated colitis. Ann. Intern. Med. 81:429433.
28. Wilcox, M. H. 2000. Respiratory antibiotic use and Clostridium difficile infection: is it the drugs or is it the doctors? Thorax 55:633634.
29. Wust, J.,, and U. Hardegger. 1983. Transferable resistance to clindamycin, erythromycin, and tetracycline in Clostridium difficile. Antimicrob. Agents Chemother. 23:784786.
30. Wust, J.,, and U. Hardegger. 1988. Studies on the resistance of Clostridium difficile to antimicrobial agents. Zentbl. Bakteriol. Mikrobiol. Hyg. A 267:383394.
31. Zadik, P. M.,, and A. P. Moore. 1998. Antimicrobial associations of an outbreak of diarrhoea due to Clostridium difficile. J. Hosp. Infect. 39:189193.


Generic image for table
Table 1

Clindamycin use prior to CDAD episodes due to the epidemic J7/J9 strain and CDAD due to nonepidemic strains in three large hospital outbreaks ( )

Citation: Gerding D, Johnson S. 2001. Clindamycin-Resistant , p 111-120. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 5. ASM Press, Washington, DC. doi: 10.1128/9781555816988.ch7
Generic image for table
Table 2

Pooled odds ratios for antibiotic use by patients with CDAD due to the epidemic J7 / J9 strain and those with CDAD due to nonepidemic strains ( )

Citation: Gerding D, Johnson S. 2001. Clindamycin-Resistant , p 111-120. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 5. ASM Press, Washington, DC. doi: 10.1128/9781555816988.ch7

This is a required field
Please enter a valid email address
Please check the format of the address you have entered.
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error