The plasmid pCD-METRO confers metronidazole resistance in Clostridioides difficile. We showed high sequence similarity among pCD-METRO plasmids from different isolates and identified pCD-METRO and associated metronidazole-resistant isolates in clinical and veterinary reservoirs in the Americas. We recommend using PCR or genomic assays to detect pCD-METRO in metronidazole-resistant C. difficile.
Keywords: Antimicrobial resistance; Brazil; Clostridioides difficile; South America; United States; bacteria; enteric infections; metronidazole; pCD-METRO; plasmid; sequence analysis; the Netherlands.