Pan-European longitudinal surveillance of antibiotic resistance among prevalent Clostridium difficile ribotypes

Abstract

Clostridium difficile infection remains a major healthcare burden. Until the recent introduction of fidaxomicin, antimicrobial treatments were limited to metronidazole and vancomycin. The emergence of epidemic C. difficile PCR ribotype 027 and its potential link to decreased antibiotic susceptibility highlight the lack of large-scale antimicrobial susceptibility and epidemiological data available. We report results of epidemiological and antimicrobial susceptibility investigations of C. difficile isolates collected prior to fidaxomicin introduction, establishing important baseline data. Thirty-nine sites in 22 countries submitted a total of 953 C. difficile isolates for PCR ribotyping, toxin testing, and susceptibility testing to metronidazole, vancomycin, fidaxomicin, rifampicin, moxifloxacin, clindamycin, imipenem, chloramphenicol, and tigecycline. Ninety-nine known ribotypes were identified. Ribotypes 027, 014, 001/072, and 078 were most frequently isolated in line with previous European studies. There was no evidence of resistance to fidaxomicin, and reduced susceptibility to metronidazole and vancomycin was also scarce. Rifampicin, moxifloxacin, and clindamycin resistance (13%, 40%, and 50% of total isolates, respectively) were evident in multiple ribotypes. There was a significant correlation between lack of ribotype diversity and greater antimicrobial resistance (measured by cumulative resistance score). Well-known epidemic ribotypes 027 and 001/072 were associated with multiple antimicrobial resistance, but high levels of resistance were also observed, particularly in 018 and closely related emergent ribotype 356 in Italy. This raises the possibility of antimicrobial exposure as the underlying reason for their appearance, and highlights the need for ongoing epidemiological and antimicrobial resistance surveillance.

Molecular characterisation of Czech Clostridium difficile isolates collected in 2013–2015

“…The second most common CE-ribotyping profile was RT 001 (n=456). In contrast with RT 176, RT 001 is frequently found in many European countries (Bauer et al, 2011;Wiuf et al, 2011;Arvand et al, 2014;Taori et al, 2014;Nyc et al, 2015;Freeman et al, 2015). In our study, the simultaneous presence of ribotypes 001 and 176 was detected in 28 of the 32 hospitals.…”

“…The Czech Republic is a country with increasing CDI incidence (1.1 cases per 10,000 patient bed-days et al, 2008;Davies et al, 2014) and relatively high rates of antibiotic resistant C. difficile strains (Freeman et al, 2015). Implementation of CDI surveillance based on the recently released CDI surveillance protocol Control (ECDC, 2015) in the Czech Republic would fill the gap in Czech CDI epidemiology with national CDI incidence data, including clinical case information and C. difficile isolate antibiotic susceptibility results.…”

Clostridium difficile infection: Early history, diagnosis and molecular strain typing methods

“…7 QIAxcel is based on an automated electrophoresis platform that processes samples in batches of 12 and allows the analysis of up to 96 samples per run. The system does not require the use of fluorescein-labelled primers and displays the data as both a gelview format and an electropherogram.…”

“…This rise has been attributed to the emergence of new hypervirulent strains, including PCRribotype 027 [5] and PCR-ribotype 078 [6], which has been associated with antimicrobial exposure. Furthermore, a significant correlation between the lack of PCR-ribotype diversity in healthcare settings and greater antimicrobial resistance has been observed [7].…”

Clostridium Difficile Infection Complicated By Toxic Megacolon In Immunocompetent Patient

“…Freeman reported, in Europe, in 2015, 0.11% Clostridium difficile strains resistant to metronidazole (MIC ≥ 8 mg/L) and 2,2% Clostridium difficile strains resistant to vancomycin (MIC ≤ 2 mg/L) [31].…”