Abstract
ObjectivesTo investigate the relationship between Clostridium (Clostridioides) difficile strain characteristics and C. difficile infection (CDI) outcome.MethodsBetween October and December 2017, 16 hospitals collected epidemiological data according to the European Centre for Disease Prevention and Control (ECDC) surveillance protocol for CDI. C. difficile isolates were characterized by ribotyping, toxin genes detection and antibiotic susceptibility testing to metronidazole, vancomycin and moxifloxacin.ResultsThe overall mean CDI incidence density was 4.5 [95% CI 3.6–5.3] cases per 10,000 patient-days. From the 433 CDI cases, 330 (76.2%) were healthcare-associated, 52 (12.0%) cases were community-associated or of unknown origin and 51 (11.8%) CDI cases recurrent; a complicated course of CDI was reported in 65 cases (15.0%). Eighty-eight (20.3%) of patients died and 59 of them within 30 days after the CDI diagnosis.From the 379 C. difficile isolates, the most prevalent PCR ribotypes were 001 (n = 127, 33.5%) and 176 (n = 44, 11.6%). A total of 186 (49.1%) isolates showed a reduced susceptibility to moxifloxacin (> 4 mg/L) and 96.4% of them had Thr82Ile in the GyrA. Nineteen isolates revealed reduced susceptibility to metronidazole and two isolates to vancomycin (> 2 mg/L).A fatal outcome was associated with a reduced susceptibility to moxifloxacin, the advanced age of the patients and a complicated course of CDI (p<0.05). No association between ribotype, binary toxin and a reduced susceptibility to moxifloxacin and complicated course or recurrent CDI was found.ConclusionsA reduced susceptibility to moxifloxacin, in causative C. difficile strains was associated with fatal outcome of the patients, therefore it is an important marker in surveillance of CDI.
Highlights
Clostridium difficile, recently reclassified as Clostridioides difficile [1], is a leading pathogen of gastrointestinal infections in hospitalised patients [2]
Between 2005 and 2013, several European multicentre studies aimed at mapping C. difficile epidemiology in Europe and an increase of C. difficile infection (CDI) incidence density was found to be concomitant with changes in prevailing ribotypes; the design of the studies varied [3]
While metronidazole and vancomycin are recommended as CDI treatment drugs [4], a reduced susceptibility to moxifloxacin a fluoroquinolone class of drug, is suggested as an epidemiological marker for certain C. difficile ribotypes spread in healthcare settings [5]
Summary
Clostridium difficile, recently reclassified as Clostridioides difficile [1], is a leading pathogen of gastrointestinal infections in hospitalised patients [2]. To standardize CDI epidemiology data collection, the European centre for disease prevention and control (ECDC) released a surveillance protocol with three options of CDI surveillance intensity (“minimal, light and enhanced”). The “minimal option” collects hospital-level CDI data, the “light version” collects CDI case-based data, including data on mortality. The “enhanced” option collects hospital data, CDI case based data and microbiological data. Microbiological data includes results on C. difficile isolates ribotyping, the presence of toxins A/B or toxin genes and antimicrobial susceptibility testing to metronidazole, vancomycin and moxifloxacin [3]. While metronidazole and vancomycin are recommended as CDI treatment drugs [4], a reduced susceptibility to moxifloxacin a fluoroquinolone class of drug, is suggested as an epidemiological marker for certain C. difficile ribotypes spread in healthcare settings [5]
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