Clostridioides difficile typing is invaluable for the investigation of both institution-specific outbreaks as well as national surveillance. While the epidemic ribotype 027 (RT027) has received a significant amount of resources and attention, ribotype 106 (RT106) has become more prevalent throughout the past decade. The purpose of this systematic review was to comprehensively summarize the genetic determinants, antimicrobial susceptibility, epidemiology, and clinical outcomes of infection caused by RT106. A total of 68 articles published between 1999 and 2019 were identified as relevant to this review. Although initially identified in the United Kingdom in 1999, RT106 is now found worldwide and became the most prevalent strain in the United States in 2016. Current data indicate that RT106 harbors the tcdA and tcdB genes, lacks binary toxin genes, and does not contain any deletions in the tcdC gene, which differentiates it from other epidemic strains, including ribotypes 027 and 078. Interestingly, RT106 produces more spores than other strains, including RT027. Overall, RT106 is highly resistant to erythromycin, clindamycin, fluoroquinolones, and third-generation cephalosporins. However, the MIC₉₀ in most studies are one to two fold dilutions below the epidemiologic cut-off values of metronidazole and vancomycin, suggesting both are acceptable treatment options from an in vitro perspective. The few clinical outcomes studies available concluded that RT106 causes less severe disease than RT027, but patients were significantly more likely to experience multiple CDI relapses when infected with a RT106 strain. Specific areas warranting future study include potential survival advantages provided by genetic elements as well as a more robust investigation of clinical outcomes associated with RT106.

艰难梭菌分型对于机构特定疫情的调查以及国家监测都非常有价值。虽然流行性核糖型 027 (RT027) 已获得大量资源和关注，但核糖型 106 (RT106) 在过去十年中变得更加流行。本系统综述的目的是全面总结 RT106 引起的感染的遗传决定因素、抗菌药物敏感性、流行病学和临床结果。 1999 年至 2019 年间发表的总共 68 篇文章被确定与本次审查相关。尽管 RT106 最初于 1999 年在英国被发现，但现已在全球范围内发现，并于 2016 年成为美国最流行的菌株。目前的数据表明，RT106 含有tcdA和tcdB基因，缺乏二元毒素基因，并且不包含任何tcdC基因缺失，这使其与其他流行菌株（包括核糖型 027 和 078）区分开来。有趣的是，RT106 比其他菌株（包括 RT027）产生更多的孢子。总体而言，RT106对红霉素、克林霉素、氟喹诺酮类和第三代头孢菌素具有高度耐药性。然而，大多数研究中的 MIC ₉₀比甲硝唑和万古霉素的流行病学临界值低一到两倍，这表明从体外角度来看，两者都是可接受的治疗选择。现有的少数临床结果研究得出结论，RT106 引起的疾病不如 RT027 严重，但患者在感染 RT106 菌株时更有可能经历多次 CDI 复发。 值得未来研究的具体领域包括遗传因素提供的潜在生存优势以及与 RT106 相关的临床结果的更强有力的研究。