Clostridium difficile infection resistance

McBride, S.M. and Sonenshein, A.L. (2011). Identification of a genetic locus responsible for antimicrobial peptide resistance in Clostridium difficile. Infect Immun 79,167-176. 

Clindamycin is a chlorine-substituted derivative of lincomycin. However it is more potent and is better absorbed from the gastrointestinal tract and has therefore replaced lincomycin in most situations. Clindamycin is in principle a bacteriostatic agent. Its indications are mainly limited to mixed anaerobic infections. As mentioned above it has a similar mechanism of action as erythromycin. It selectively inhibits bacterial protein synthesis by binding to the same 50s ribosomal subunits. Erythromycin and clindamycin can interfere with each other by competing for this receptor. Also cross-resistance with erythromycin frequently occurs. Resistance is rather chromosomal rather than plasmid mediated and is especially found in cocci and Clostridium difficile. 

Daptomycin has proven efficacy in a number of in vivo animal models, including soft tissue infections by MRSA, bacteraemia caused by S. aureus or vancomycin-resistant enterococci (VRE), Enterococcus faecalis pyelonephritis, MRSA osteomyelitis, MRSA and Bacillus anthracis pulmonary infections, Gram-positive endocarditis, Clostridium difficile colitis and S. pneumoniae and S. aureus meningitis.9,64 66... 

Giry M, Popoff MR, Eichel-Streiber Cv, et al. (1995) Transient expression of RhoA, -B, and -C GTPases in HeLa cells potentiates resistance to Clostridium difficile toxins A and B but not to Clostridium sordellii lethal toxin. In Infect Immun. 63 4063-4071. 

Vancomycin is an antibiotic used to treat Staphylococcus and Clostridium difficile.These bacteria infect bones and joints and cause endocarditis and enterocolitis. Vancomycin is commonly prescribed to patients who are susceptible to endocarditis to prevent this infection from occurring. Vancomycin is particularly successful in treating methicillin-resistant strains of bacteria. However, parenteral vancomycin is not used to treat antibiotic-associated pseudomembranous colitis. 

Answer E. Vancomycin is usually considered to be a backup drug to metronidazole in colitis due to Clostridium difficile on the grounds that it is no more effective, is more costly, and should be reserved for treatment of resistant gram-positive coccal infections. None of the other drugs has activity in pseudomembranous colitis—indeed, they may cause it ... 

Invisible killers such as Methicillin Resistant Staphylococcus aureus (MRSA) and other antibiotic resistant pathogens such as Clostridium difficile are a major cause of morbidity and mortality within hospitals worldwide. Current statistics put Ae instances of Hospital Acquired Infection at 300,000 per year incurring an added cost to the health service due to H.A.I. s. In 2000 the estimated cost to the NHS was as much as 1 billion. With instances of HAI s increasing (cases of C-DifBcile rose by 17% in 2005) the need to prevent cross-infection and reduce environmental contamination in hospitals has never been greater. 

Observational studies Oral moxifloxacin (after initial intravenous cloxacillin, cefazo-lin or vancomycin) was studied in 48 patients with orthopedic implant infections due to sensitive Staphylococcus aureus ( = 33) or coagulase-negative staphylococci ( = 15) [40 ]. Overall cure rate was 83% and 71% if the implant was retained. Two subjects withdrew because of side-effects (4.2% 95% Cl = 0,9.5) with one case each of Clostridium difficile colitis and persistent dizziness. Eight relapses occurred, but in the six cases in which the organism was re-isolated resistance did not develop. 

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