The changes of PCR ribotype and antimicrobial resistance of Clostridium difficile in a tertiary care hospital over 10 years

Abstract

The aims of this study were to investigate any change in PCR ribotypes and to determine the antimicrobial resistance of common PCR ribotypes over a 10-year period in a tertiary care hospital. We conducted PCR ribotyping, antimicrobial susceptibility testing and DNA gyrase sequencing to identify changes in 1407 Clostridium difficile non-duplicated isolates obtained between 2000 and 2009. A total of 74 different ribotypes were found. The most prevalent ribotype was ribotype 001 (26.1 %). The prevalence of ribotype 017 was 17 % and that of ribotype 014/020 was 9.6 %. Ribotyping showed that the prevalence of ribotype 001 decreased and the prevalence of ribotypes 017, 014/020 and 018 increased over the 10 years. Antimicrobial resistance rates in prevalent ribotypes were: clindamycin, 81 %; cefotetan, 19 %; moxifloxacin, 42 %; imipenem, 8 %; ciprofloxacin, 100 % and erythromycin, 80 %. Ribotype 018 showed greater antimicrobial resistance than other ribotypes. All ribotype 018 strains showing moxifloxacin resistance had a substitution of a gyrA coding amino acid (Thr82 to Ile). This study will help the understanding of PCR ribotype trends and antimicrobial resistance of C. difficile in Korea.

Predominance of PCR-ribotypes, 018 (smz) and 369 (trf) of Clostridium difficile in Japan: a potential relationship with other global circulating strains?

“…Evolutionary comparative analysis and determination of factors exclusive to each strain will allow understanding of the preferential establishment of one or another, such as of 369 in Japan and type 017 in Europe. High resistance against erythromycin and clindamycin was observed in all type 369 isolates tested, which is consistent with previous reports on type 017 strains (Kuijper et al, 2001;Pituch et al, 2011;Lee et al, 2014;Freeman et al, 2015). In addition, 94.1 % (32/34) and 67.6 % (23/34) of type 369 isolates examined by this study were resistant to gatifloxacin and moxifloxacin, respectively.…”

“…In addition, 94.1 % (32/34) and 67.6 % (23/34) of type 369 isolates examined by this study were resistant to gatifloxacin and moxifloxacin, respectively. Resistance against new fluoroquinolones in PCR-ribotype 017 was also reported from other countries (Pituch et al, 2011;Spigaglia et al, 2011;Lee et al, 2014;Freeman et al, 2015), indicating the need to pay more attention to isolates belonging to toxinotype VIII, which have shown multi-resistance tendencies.…”

“…The reports from all these countries, except Japan, documented that the vast majority of these A 2 B + isolates were found to be of PCR-ribotype 017 (Kuijper et al, 2001;Drudy et al, 2007;Goorhuis et al, 2009;Pituch et al, 2011;Hawkey et al, 2013;Lee et al, 2014). PCRribotype 017 was identified in 4 % of isolates from 34 European countries (Davies et al, 2014) and 2.2 % of isolates from 32 hospitals in the USA (Tickler et al, 2014).…”

Prevalence and molecular epidemiology of Clostridium difficile infection in Thailand

“…An earlier study investigating the molecular epidemiology of C. difficile collected between 2006 and 2008 from inpatients at Siriraj Hospital also reported RTs 017 (41.5%) and 014/020 group (20.7%) among the top RTs [9]. Additionally, RT 014/020 group was reported to be highly prevalent among humans in Australia [20], Korea [25], Europe [19], [26] and North America [27]. In contrast, RT 046, which was previously reported as the third most common RT at Siriraj Hospital (6/53), was not found [9].…”

Clostridium difficile PCR Ribotype 018, a Successful Epidemic Genotype

“…The success of an epidemic strain relies not only on its ability to cause disease (virulence) but also on its transmissibility. Indeed, depending on the country and the time period, different RTs, such as RT001, RT017, and RT014/020, have been reported as prevalent and associated with severe infections and large outbreaks in hospital settings (12)(13)(14)(15).…”