Clostridioides difficile in Calves in Central Italy: Prevalence, Molecular Typing, Antimicrobial Susceptibility and Association with Antibiotic Administration.

Ilenia Drigo,Claudio Forte,Carmela Lovito,Silvia Tofani,Carmen Maresca,Elisa Albini,Serenella Orsini,Chiara Francesca Magistrali,Francesca Romana Massacci,Luca Bano,Francesca Blasi,Eleonora Scoccia,Sara Primavilla,Gastone Dalmonte

doi:10.3390/ani11020515

Abstract

Simple SummaryClostridioides difficile is a leading cause of nosocomial and community-acquired diarrhoea in men. The infection most commonly occurs in people who have recently been treated with antibiotics. Indistinguishable C. difficile strains have been isolated from livestock and humans, which has shed light on a possible zoonotic origin of this infection. This study aimed to assess the prevalence and risk factors of C. difficile in calves bred in dairy and beef cattle farms of the Umbria, central Italy. We estimated a 19.8% prevalence of farms positive for C. difficile. The C. difficile isolates from calves were potentially toxigenic and resistant to antibiotics, including lincosamides, quinolones, vancomycin and linezolid. Isolates belonging to ribotype RT-126, which is also commonly reported in humans, showed the highest number of resistance to the antimicrobials tested. Furthermore, we observed an almost sixfold increased risk for C. difficile on farms where penicillins had been prescribed. This, together with the detection of toxigenic and antibiotic-resistant isolates, strongly suggests the need for a reduction of antibiotic use in cattle.The emergence of Clostridioides difficile as the main agent of antibiotic-associated diarrhoea has raised concerns about its potential zoonotic role in different animal species. The use of antimicrobials is a major risk factor for C. difficile infection. Here, we provide data on C. difficile infection in dairy and beef calves in Umbria, a region in central Italy. This cross-sectional study focuses on prevalence, risk factors, ribotypes, toxinotypes and antimicrobial resistance profiles of circulating ribotypes. A prevalence of 19.8% (CI95%, 12–27.6%) positive farms was estimated, and the prescription of penicillins on the farms was associated with C. difficile detection (OR = 5.58). Eleven different ribotypes were found, including the ST11 sublineages RT-126 and -078, which are also commonly reported in humans. Thirteen isolates out of 17 showed resistance to at least one of clindamycin, moxifloxacin, linezolid and vancomycin. Among them, multiple-drug resistance was observed in two isolates, belonging to RT-126. Furthermore, RT-126 isolates were positive for tetracycline resistance determinants, confirming that tetracycline resistance is widespread among ST11 isolates from cattle. The administration of penicillins increased the risk of C. difficile in calves: this, together with the recovery of multi-resistant strains, strongly suggests the need for minimising antibiotic misuse on cattle farms.

Highlights

The Gram-positive, spore-forming, anaerobic bacterium Clostridioides difficile (Clostridium difficile) is recognised as the main antibiotic agent associated with diarrhoea in human medicine and a major rising cause of gastrointestinal infection in animals [1,2]
RT-126, -033, -078 and -010 turned out to be the most common ribotypes, each isolated from more than one farm. This finding is in accordance with what we have reported in calves in Italy [17] and is consistent with the literature, which indicates that these ribotypes as the most common ones in neonatal calves and piglets in Europe and
The zoonotic hypothesis is supported by the isolation of indistinguishable strains from different animal species and humans [14]

Summary

Introduction

The Gram-positive, spore-forming, anaerobic bacterium Clostridioides difficile (Clostridium difficile) is recognised as the main antibiotic agent associated with diarrhoea in human medicine and a major rising cause of gastrointestinal infection in animals [1,2]. C. difficile infection in humans (CDI) may cause mild to severe colitis. Pseudomembranous colitis represents the most typical and severe manifestation [3,4]. CDI has been described as a nosocomial infection, associated with antibiotic treatment and hospitalisation as important risk factors in humans. The rapid changing of epidemiology and the recent increase of CDI in the community placed the attention on C. difficile exposure outside the hospital. The potential role of animals as a reservoir for community CDI has been investigated and described in many studies worldwide [7,8,9,10,11]

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