Abstract
Clostridium difficile infection (CDI) is a leading and an important cause of diarrhea in a healthcare setting especially in industrialized countries. Community-associated CDI appears to add to the burden on healthcare setting problems. The aim of the study was to investigate the antimicrobial resistance of healthcare-associated and community-acquired C. difficile infection over 5 years (2008–2012) in Kuwait. A total of 111 hospital-acquired (HA-CD) and 35 community-acquired Clostridium difficile (CA-CD) clinical isolates from stool of patients with diarrhoea were studied. Antimicrobial susceptibility testing of 15 antimicrobial agents against these pathogens was performed using E test method. There was no evidence of resistance to amoxicillin-clavulanic acid, daptomycin, linezolid, piperacillin-tazobactam, teicoplanin and vancomycin by both HA-CD and CA-CD isolates. Metronidazole had excellent activity against CA-CD but there was a 2.9% resistance rate against HA-CD isolates. Ampicillin, clindamycin, levofloxacin and imipenem resistance rates among the HC-CD vs. CA-CD isolates were 100 vs. 47.4%; 43 vs. 47.4%; 100 vs. 100% and 100 vs. 89%, respectively. An unexpected high rifampicin resistance rate of 15.7% emerged amongst the HA-CD isolates. In conclusion, vancomycin resistance amongst the HA-CD and CA-CD isolates was not encountered in this series but few metronidazole resistant hospital isolates were isolated. High resistance rates of ampicillin, clindamycin, levofloxacin, and imipenem resistance were evident among both CA-CD and HA-CD isolates. Rifampicin resistance is emerging among the HA-CD isolates.
Highlights
Clostridium difficile is a Gram-positive, spore-forming anaerobic bacteria
There was no significant difference in the resistance against HA-CD and community-acquired Clostridium difficile (CA-CD) isolates for the above antimicrobial agents
Resistance to imipenem was very common among both HA-CD and CA-CD isolates MIC90 >32 vs. >32 μg/ml and 89% and 100%; p = 0.07; while resistance to meropenem was more common among CA-CD compared to HA-CD (MIC90 = >32 vs. 1 μg/ml; 43 vs. 0%; p
Summary
Clostridium difficile is a Gram-positive, spore-forming anaerobic bacteria. It has an important role in hospital-acquired diarrhoea ranging from mild cases to severe pseudomemraneous colitis, collectively named C. difficile infection (CDI). Antimicrobial Susceptibility Pattern of Hospital- and Community-Acquired Clostridium difficile Isolates. 2002 in North America [1], Europe [2] and Australia [3]. This is partially related to the emergence of the hypervirulent strains i.e. C_difficile B1/ NAP1/027 [4]. Another hypervirulent strain i.e. C_difficile ribotype 078 has emerged, whose incidence increased from 3 to 13% during 2005–2008 in the Netherlands [4]. New risk groups have been added to the list which include community-onset CDI [5, 6], CDI in children as well as peripartum ladies [7]
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