Antimicrobial Susceptibility of Clostridioides difficile in Spain: Multicenter Retrospective Cohort Study

Background/Objetives: The objective of this study was to determine the in vitro susceptibility profiles of clinical Clostridioides difficile isolates to metronidazole (MTZ), vancomycin (VAN), fidaxomicin (FDX), tigecycline (TGC), and eravacycline (ERV) in a multicenter Spanish cohort, and to evaluat...

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Autores: Ventero, MP, Valverde-Fredet, MD, Merino, E, Herrero, R, Germak, IT, Rodríguez-Fernández, M, Ramos-Rincón, JM, Garcia, M, Delgado-Sánchez, E, Navarrete-Lorite, MN, Gil, C, Tasias, M, Caston, JJ, Vinuesa-Garcia, D, Gomez-Ayerbe, C, Marcos, FJM, Merchante, N, Rodríguez, JC
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2026
País:España
Institución:Universidad de Málaga
Repositorio:r-FISABIO. Repositorio Institucional de Producción Científica
OAI Identifier:oai:dnet:r-fisabio___::5b5ef15e9414a041369545ec7f36cd1f
Acceso en línea:https://fisabio.portalinvestigacion.com/publicaciones/20514
Access Level:acceso abierto
Palabra clave:<italic>Clostridioides difficile</italic> infection
vancomycin
eravacycline
metronidazole
fidaxomicin
tigecycline
resistant isolates
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oai_identifier_str oai:dnet:r-fisabio___::5b5ef15e9414a041369545ec7f36cd1f
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spelling Antimicrobial Susceptibility of Clostridioides difficile in Spain: Multicenter Retrospective Cohort StudyVentero, MPValverde-Fredet, MDMerino, EHerrero, RGermak, ITRodríguez-Fernández, MRamos-Rincón, JMGarcia, MDelgado-Sánchez, ENavarrete-Lorite, MNGil, CTasias, MCaston, JJVinuesa-Garcia, DGomez-Ayerbe, CMarcos, FJMMerchante, NRodríguez, JC<italic>Clostridioides difficile</italic> infectionvancomycineravacyclinemetronidazolefidaxomicintigecyclineresistant isolatesBackground/Objetives: The objective of this study was to determine the in vitro susceptibility profiles of clinical Clostridioides difficile isolates to metronidazole (MTZ), vancomycin (VAN), fidaxomicin (FDX), tigecycline (TGC), and eravacycline (ERV) in a multicenter Spanish cohort, and to evaluate their association with clinical factors. Methods: Strains were obtained from prospectively included patients in the ICD-ANCRAID-SEICV cohort (ClinicalTrials.gov ID: NCT04801862) in Andaluc & iacute;a and the Valencian Community between 1 January 2020 and 30 April 2023. Antimicrobial susceptibility testing was performed using E-test for MTZ, VAN, TGC, and ERV, and agar dilution for FDX. Results: The results were interpreted following EUCAST clinical breakpoints and ECOFF criteria. A total of 107 patients were included (median age 70 years; 65.4% women). Nearly half of the cases were community-acquired, 30% nosocomial, and the remainder healthcare-associated. Most infections were non-severe, and 32.7% experienced recurrence. Overall resistance levels were low: VAN and TGC each showed resistance in 2.8% of isolates, followed by MTZ (1.9%). Only one isolate was resistant to FDX (0.9%), and none to ERV. MIC90 values were low for all agents. Some resistant isolates displayed co-resistance and were recovered from patients with prior antibiotic exposure. Among the seven patients carrying resistant strains, most were women, and the cases were predominantly community-acquired. Clinical characteristics, including age, comorbidity, infection origin, and severity, did not differ from those with susceptible isolates. All patients achieved clinical cure without recurrent infection. No association was found between elevated MIC values and recurrence or greater severity. Conclusions: FDX and ERV demonstrated excellent in vitro activity. Resistance to MTZ, VAN, and TGC was uncommon but detectable. Findings highlight the need for continued antimicrobial resistance surveillance and evaluation of its potential clinical impact.MDPI2026info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://fisabio.portalinvestigacion.com/publicaciones/20514Antibiotics-BaselISSN: 20796382reponame:r-FISABIO. Repositorio Institucional de Producción Científicainstname:Universidad de MálagaInglésinfo:eu-repo/semantics/openAccessoai:dnet:r-fisabio___::5b5ef15e9414a041369545ec7f36cd1f2026-06-11T12:45:17Z
dc.title.none.fl_str_mv Antimicrobial Susceptibility of Clostridioides difficile in Spain: Multicenter Retrospective Cohort Study
title Antimicrobial Susceptibility of Clostridioides difficile in Spain: Multicenter Retrospective Cohort Study
spellingShingle Antimicrobial Susceptibility of Clostridioides difficile in Spain: Multicenter Retrospective Cohort Study
Ventero, MP
<italic>Clostridioides difficile</italic> infection
vancomycin
eravacycline
metronidazole
fidaxomicin
tigecycline
resistant isolates
title_short Antimicrobial Susceptibility of Clostridioides difficile in Spain: Multicenter Retrospective Cohort Study
title_full Antimicrobial Susceptibility of Clostridioides difficile in Spain: Multicenter Retrospective Cohort Study
title_fullStr Antimicrobial Susceptibility of Clostridioides difficile in Spain: Multicenter Retrospective Cohort Study
title_full_unstemmed Antimicrobial Susceptibility of Clostridioides difficile in Spain: Multicenter Retrospective Cohort Study
title_sort Antimicrobial Susceptibility of Clostridioides difficile in Spain: Multicenter Retrospective Cohort Study
dc.creator.none.fl_str_mv Ventero, MP
Valverde-Fredet, MD
Merino, E
Herrero, R
Germak, IT
Rodríguez-Fernández, M
Ramos-Rincón, JM
Garcia, M
Delgado-Sánchez, E
Navarrete-Lorite, MN
Gil, C
Tasias, M
Caston, JJ
Vinuesa-Garcia, D
Gomez-Ayerbe, C
Marcos, FJM
Merchante, N
Rodríguez, JC
author Ventero, MP
author_facet Ventero, MP
Valverde-Fredet, MD
Merino, E
Herrero, R
Germak, IT
Rodríguez-Fernández, M
Ramos-Rincón, JM
Garcia, M
Delgado-Sánchez, E
Navarrete-Lorite, MN
Gil, C
Tasias, M
Caston, JJ
Vinuesa-Garcia, D
Gomez-Ayerbe, C
Marcos, FJM
Merchante, N
Rodríguez, JC
author_role author
author2 Valverde-Fredet, MD
Merino, E
Herrero, R
Germak, IT
Rodríguez-Fernández, M
Ramos-Rincón, JM
Garcia, M
Delgado-Sánchez, E
Navarrete-Lorite, MN
Gil, C
Tasias, M
Caston, JJ
Vinuesa-Garcia, D
Gomez-Ayerbe, C
Marcos, FJM
Merchante, N
Rodríguez, JC
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv <italic>Clostridioides difficile</italic> infection
vancomycin
eravacycline
metronidazole
fidaxomicin
tigecycline
resistant isolates
topic <italic>Clostridioides difficile</italic> infection
vancomycin
eravacycline
metronidazole
fidaxomicin
tigecycline
resistant isolates
description Background/Objetives: The objective of this study was to determine the in vitro susceptibility profiles of clinical Clostridioides difficile isolates to metronidazole (MTZ), vancomycin (VAN), fidaxomicin (FDX), tigecycline (TGC), and eravacycline (ERV) in a multicenter Spanish cohort, and to evaluate their association with clinical factors. Methods: Strains were obtained from prospectively included patients in the ICD-ANCRAID-SEICV cohort (ClinicalTrials.gov ID: NCT04801862) in Andaluc & iacute;a and the Valencian Community between 1 January 2020 and 30 April 2023. Antimicrobial susceptibility testing was performed using E-test for MTZ, VAN, TGC, and ERV, and agar dilution for FDX. Results: The results were interpreted following EUCAST clinical breakpoints and ECOFF criteria. A total of 107 patients were included (median age 70 years; 65.4% women). Nearly half of the cases were community-acquired, 30% nosocomial, and the remainder healthcare-associated. Most infections were non-severe, and 32.7% experienced recurrence. Overall resistance levels were low: VAN and TGC each showed resistance in 2.8% of isolates, followed by MTZ (1.9%). Only one isolate was resistant to FDX (0.9%), and none to ERV. MIC90 values were low for all agents. Some resistant isolates displayed co-resistance and were recovered from patients with prior antibiotic exposure. Among the seven patients carrying resistant strains, most were women, and the cases were predominantly community-acquired. Clinical characteristics, including age, comorbidity, infection origin, and severity, did not differ from those with susceptible isolates. All patients achieved clinical cure without recurrent infection. No association was found between elevated MIC values and recurrence or greater severity. Conclusions: FDX and ERV demonstrated excellent in vitro activity. Resistance to MTZ, VAN, and TGC was uncommon but detectable. Findings highlight the need for continued antimicrobial resistance surveillance and evaluation of its potential clinical impact.
publishDate 2026
dc.date.none.fl_str_mv 2026
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://fisabio.portalinvestigacion.com/publicaciones/20514
url https://fisabio.portalinvestigacion.com/publicaciones/20514
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv MDPI
publisher.none.fl_str_mv MDPI
dc.source.none.fl_str_mv Antibiotics-Basel
ISSN: 20796382
reponame:r-FISABIO. Repositorio Institucional de Producción Científica
instname:Universidad de Málaga
instname_str Universidad de Málaga
reponame_str r-FISABIO. Repositorio Institucional de Producción Científica
collection r-FISABIO. Repositorio Institucional de Producción Científica
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,811543

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