Macrolide-lincosamide-streptogramin B resistance in Clostridium difficile is mostly due to the ermB resistance determinant. Here, we describe a sensitive and rapid molecular method to detect ermB in C. difficile to contribute to the wider epidemiological study. Five sets of loop-mediated isothermal amplification (LAMP) primers were designed and optimized for rapid detection of ermB. The specificity and sensitivity of the primers for ermB were detected, and the ermB LAMP assay was compared to conventional PCR with 80 clinical isolates of C. difficile. Real-time monitoring of turbidity and chromogenic reaction were used to determine negative and positive results. A total of 26 pathogenic bacterial strains of different species were found to be negative for ermB, which indicated the high specificity of the primers. ermB was detected in 78.8 % (63/80) of the clinical isolates by both LAMP and conventional PCR. The detection limit of LAMP was 36.1 pg DNA ml 21 and its sensitivity was 10-fold greater than that of conventional PCR. This study is the first report regarding the development and application of the LAMP assay for detection of the ermB gene in C. difficile strains. The developed LAMP method is sensitive, specific and provides a user-friendly visual approach for the rapid detection of ermB-bearing C. difficile.
Received 27 March 2015Accepted 13 June 2015
INTRODUCTIONClostridium difficile is a causative agent of antibiotic-associated diarrhoea and pseudomembranous colitis, usually as a consequence of antimicrobial therapy. During the last few decades, C. difficile infection (CDI) has become more severe, more recurrent, more resistant to antibiotics and more refractory to standard treatment, which poses a significant burden on patients, healthcare systems and society in general. Estimates suggest that the annual costs for management of CDI amount to more than $3 billion in the USA and J3 billion in Europe (Bouza, 2012;McGlone et al., 2012). Major risk factors for CDI include hospitalization, advanced age and antibiotic exposure, the latter including clindamycin and erythromycin (Aziz et al., 2001;Gerding, 1989;Kelly et al., 1994;Slimings & Riley, 2014). The majority of epidemic isolates are resistant to clindamycin, erythromycin, broad-spectrum cephalosporins and fluoroquinolones (Johnson et al., 1999; Spigaglia et al., 2011;Slimings & Riley, 2014). Thus, resistance to clindamycin and erythromycin, two antibiotics of the macrolidelincosamide-streptogramin B (MLSB) group, would further increase the risk of CDI.In C. difficile, resistance to the MLSB group of antibiotics is mainly encoded by the ermB resistance determinant. The ermB gene encodes a 23S rRNA methyltransferase that modifies the target site for the antibiotic and is located on a specific mobilizable non-conjugative element, Tn5398 (Farrow et al., 2001). However, the ermB gene is located on elements other than Tn5398 in the majority of clinical isolates. In total, 17 genetic organizations of such elements 3These authors contributed equally to this work...