<i>Clostridium difficile</i>
            Isolates Resistant to Fluoroquinolones in Italy: Emergence of PCR Ribotype 018

Spigaglia, Patrizia; Barbanti, Fabrizio; Dionisi, Anna Maria; Mastrantonio, Paola

doi:10.1128/jcm.02482-09

Cited by 87 publications

(72 citation statements)

References 35 publications

(52 reference statements)

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“…Decreased susceptibility to moxifloxacin has been found in several C. difficile types isolated in Europe and worldwide, and appears to be common in dominant types including 001, 018, 027 and 106 in, for example, England [7], Scotland [27], Germany [28] and Italy [5]. We found decreased susceptibility mainly in types 012, 017, 046 and 231/SE37.…”

Section: Discussionsupporting

confidence: 50%

“…Despite reports of increased prevalence of moxifloxacin resistance in C. difficile [5,[31][32][33], including outbreaks of C. difficile 027 occurring shortly after replacing levofloxacin with moxifloxacin/gatifloxacin [34], it is currently unclear whether moxifloxacin use implies higher risk for C. difficile infection than other commonly used antibiotics [35][36][37][38]. Thus, we can neither confirm nor exclude the possibility that moxifloxacin has contributed to the selection of types 046 and 012 in certain Swedish counties.…”

Section: Discussionmentioning

confidence: 82%

“…The proportion of C. difficile isolates with reduced susceptibility to moxifloxacin was 16% in Sweden 2009 and thus less than half of the 37.5% reported in Europe in 2005 [5]. Decreased susceptibility to moxifloxacin has been found in several C. difficile types isolated in Europe and worldwide, and appears to be common in dominant types including 001, 018, 027 and 106 in, for example, England [7], Scotland [27], Germany [28] and Italy [5].…”

Section: Discussionmentioning

confidence: 99%

“…Hospital-based studies performed in 1999 to 2001 showed that nosocomial spread of C. difficile was rare in Swedish hospitals in which infection control routines were implemented, although there were small outbreaks associated with multiresistant PCR-ribotype 012/SE17 [2][3][4]. Many outbreaks involving other C. difficile types have been reported in Europe and the rest of the world [5][6][7][8], particularly those caused by moxifloxacin-resistant PCR-ribotype 027/PFGE NAP1 [9][10][11][12][13][14][15][16][17] …”

Section: Introductionmentioning

confidence: 99%

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Geographical clustering of cases of infection with moxifloxacin-resistant Clostridium difficile PCR-ribotypes 012, 017 and 046 in Sweden, 2008 and 2009

et al. 2011

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We report the results of two nationwide surveillance studies of Clostridium difficile infection conducted during 2008 and 2009 in Sweden. The first study aimed to identify and quantify the proportion of C. difficile isolates with decreased susceptibility to moxifloxacin, particularly those of PCR-ribotype 027. From December 2007 to September 2008, 20 of 28 regional laboratories sent 585 isolates to the Swedish Institute for Infectious Disease Control for typing. A majority of the isolates (454 of 585; 78%) belonged to four PCR ribotypes (012, SE37, 017 and 046), all clustered in geographical regions. Only two type 027 isolates were found, both from the same patient. In the second study, involving all 28 regional laboratories, all consecutive C. difficile isolates collected during two time periods in 2009 (n=364) were typed and tested for susceptibility to clindamycin, erythromycin, moxifloxacin, metronidazole and vancomycin. The three most common PCR ribotypes were SE21, 001 and 020 (22% of all isolates). Types 012, 017, and 046 were geographically clustered and associated with decreased susceptibility to moxifloxacin, clindamycin and erythromcin. The extent of moxifloxacin prescription was highly variable among counties, indicating a need for careful monitoring of prescription rates to follow its role in C. difficile epidemiology.

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Section: Discussionsupporting

confidence: 50%

Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Geographical clustering of cases of infection with moxifloxacin-resistant Clostridium difficile PCR-ribotypes 012, 017 and 046 in Sweden, 2008 and 2009

et al. 2011

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“…Resistance to newer fluoroquinolones has been described not only in the hypervirulent strain 027 but also in other emerging PCR ribotypes circulating in hospital settings (Pituch et al, 2007;Spigaglia et al, 2010). In a European prospective study conducted in 2005, strains resistant to moxifloxacin represented 37.5 % of all C. difficile clinical isolates and the majority of the fluoroquinolone-resistant isolates belonged to PCR ribotype 126 or 018 (Barbut et al, 2007).…”

Section: Discussionmentioning

confidence: 99%

Characterization and antimicrobial susceptibility of Clostridium difficile strains isolated from adult patients with diarrhoea hospitalized in two university hospitals in Poland, 2004–2006

Pituch

Obuch-Woszczatyński

Wultańska

et al. 2011

Journal of Medical Microbiology

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Characterization and antimicrobial susceptibility of Clostridium difficile strains isolated from adult patients with diarrhoea hospitalized in two university hospitals in Poland, 2004Poland, -2006 This study analysed 330 Clostridium difficile strains isolated from patients with C. difficile infection who were hospitalized in two university hospitals (H1 and H2) in Warsaw, Poland, over the period [2004][2005][2006]. Strains were investigated for the presence of tcdA (A), tcdB (B) and binary toxin (CDT) genes, and antimicrobial susceptibility was determined against nine agents. Among the 330 C. difficile isolates, 150 (45.4 %) were classified as A + B + CDT " , 18 (5.5 %) as A + B + CDT + , 144 (43.6 %) as A " B + CDT " and 18 (5.5 %) as A " B " CDT " . The predominant PCR ribotype in hospitals H1 and H2 was type 017 and accounted for 48.3 and 40.0 %, respectively. Only one PCR ribotype 027 strain was found. The rates of resistance to erythromycin and clindamycin in hospitals H1 and H2 were 53.6 and 53.6 %, and 48.6 and 47.5 %, respectively, whereas resistance rates to the newer fluoroquinolones gatifloxacin and moxifloxacin were 38.5 and 38.5 % (H1) and 38.4 and 40.1 % (H2). Erythromycin resistance was frequently associated with resistance to clindamycin and newer fluoroquinolones in strains belonging to type 017. No metronidazole-and vancomycin-resistant isolates were found, although two C. difficile isolates had elevated MIC values of metronidazole (MIC range 1.0"1.5 mg l "1 ) and 15 strains revealed elevated MIC values for vancomycin (MIC range 1.5-2.0 mg l "1 ). In conclusion, an increase in non-027 CDT-producing C. difficile strains was observed in Poland, but C. difficile PCR ribotype 017 remains a major circulating type. INTRODUCTIONClostridium difficile is a major cause of antibioticassociated diarrhoea in hospitalized patients (Freeman et al., 2010). Toxigenic isolates usually produce two toxins: toxin A (A) and toxin B (B). A 2 B + strains do not produce detectable amounts of toxin A due to a deletion in the repeating sequence of the tcdA gene encoding the toxin (Kato et al., 1998). Some C. difficile strains produce a third additional toxin, called C. difficile binary toxin (CDT), which can enhance the attachment of C. difficile to intestinal epithelial cells (Schwan et al., 2009)

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Ribotypes and New Virulent Strains Across Europe

Couturier,

Davies,

Barbut

2024

Advances in Experimental Medicine and Biology

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Clostridium difficile Isolates Resistant to Fluoroquinolones in Italy: Emergence of PCR Ribotype 018

Cited by 87 publications

References 35 publications

Geographical clustering of cases of infection with moxifloxacin-resistant Clostridium difficile PCR-ribotypes 012, 017 and 046 in Sweden, 2008 and 2009

Geographical clustering of cases of infection with moxifloxacin-resistant Clostridium difficile PCR-ribotypes 012, 017 and 046 in Sweden, 2008 and 2009

Characterization and antimicrobial susceptibility of Clostridium difficile strains isolated from adult patients with diarrhoea hospitalized in two university hospitals in Poland, 2004–2006

Ribotypes and New Virulent Strains Across Europe

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