An Outbreak of Clostridium (Clostridioides) difficile Infections within an Acute and Long-Term Care Wards Due to Moxifloxacin-Resistant PCR Ribotype 176 Genotyped as PCR Ribotype 027 by a Commercial Assay

Novakova, Elena; Kotlebova, Nina; Gryndlerova, Anezka; Novak, Martin; Vladarova, Michala; Wilcox, Mark; Kuijper, Ed; Krutova, Marcela

doi:10.3390/jcm9113738

Open AccessArticle

An Outbreak of Clostridium (Clostridioides) difficile Infections within an Acute and Long-Term Care Wards Due to Moxifloxacin-Resistant PCR Ribotype 176 Genotyped as PCR Ribotype 027 by a Commercial Assay

by

Elena Novakova

¹,

Nina Kotlebova

¹

,

Anezka Gryndlerova

²,

Martin Novak

¹,

Michala Vladarova

³,

Mark Wilcox

^4,†,

Ed Kuijper

^5,† and

Marcela Krutova

^2,*,†

¹

Department of Microbiology and Immunology, Comenius University Jessenius Faculty of Medicine, 036 01 Martin, Slovakia

²

Department of Medical Microbiology, Charles University, 2nd Faculty of Medicine and Motol University Hospital, 150 06 Prague, Czech Republic

³

Department of Clinical Microbiology, Clinical Biochemistry Inc., 012 07 Zilina, Slovakia

⁴

Healthcare Associated Infection Research Group, Leeds Teaching Hospitals NHS Trust & University of Leeds, Leeds LS2 9JT, UK

⁵

Department of Medical Microbiology, Leiden University Medical Centre, 2300 Leiden, The Netherlands

^*

Author to whom correspondence should be addressed.

^†

European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Clostridioides difficile (ESGCD).

J. Clin. Med. 2020, 9(11), 3738; https://doi.org/10.3390/jcm9113738

Submission received: 6 October 2020 / Revised: 9 November 2020 / Accepted: 18 November 2020 / Published: 20 November 2020

(This article belongs to the Special Issue Clostridium difficile Infection: Unmet Needs and Unsolved Questions)

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Abstract

We aimed to characterize Clostridioides difficile isolates cultured during a six-month single-center study from stool samples of patients with C. difficile infection (CDI) genotyped by the Xpert^®C. difficile/Epi assay by polymerase chain reaction (PCR) ribotyping, toxin genes’ detection and multi-locus variable number tandem repeats analysis (MLVA). The susceptibility to metronidazole, vancomycin and moxifloxacin was determined by agar dilution. In addition, the presence of Thr82Ile in the GyrA and a single nucleotide deletion at position (Δ117) in the tcdC gene were investigated. Between January 1 and June 30, 2016, of 114 CDIs, 75 cases were genotyped as presumptive PCR ribotype (RT) 027 infections using a commercial assay. C. difficile isolates cultured from presumptive RT027 stool samples belonged to RT176. These isolates carried genes for toxin A (tcdA), B (tcdB), binary (cdtA/B) and had Δ117 in the tcdC gene. Using MLVA, the 71/75 isolates clustered into two clonal complexes (CCs). Of these, 39 isolates (54.9%) were from patients hospitalized in acute care and 32 isolates (45.1%) were isolated from patients hospitalized in the long-term care department. All isolates were susceptible to metronidazole and vancomycin, and 105 isolates were resistant to moxifloxacin (92%) carrying Thr83Ile in the GyrA. An outbreak of RT176 CDIs, suspected as RT027, was recognized in a Slovakian hospital. In order to monitor the emergence and spread of RT027-variants, the identification of a presumptive RT027 CDI should be confirmed at a strain level by PCR ribotyping.

Keywords: ribotyping; Slovakia; MLVA; Thr82Ile; tcdC; Δ117; binary toxin

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MDPI and ACS Style

Novakova, E.; Kotlebova, N.; Gryndlerova, A.; Novak, M.; Vladarova, M.; Wilcox, M.; Kuijper, E.; Krutova, M. An Outbreak of Clostridium (Clostridioides) difficile Infections within an Acute and Long-Term Care Wards Due to Moxifloxacin-Resistant PCR Ribotype 176 Genotyped as PCR Ribotype 027 by a Commercial Assay. J. Clin. Med. 2020, 9, 3738. https://doi.org/10.3390/jcm9113738

AMA Style

Novakova E, Kotlebova N, Gryndlerova A, Novak M, Vladarova M, Wilcox M, Kuijper E, Krutova M. An Outbreak of Clostridium (Clostridioides) difficile Infections within an Acute and Long-Term Care Wards Due to Moxifloxacin-Resistant PCR Ribotype 176 Genotyped as PCR Ribotype 027 by a Commercial Assay. Journal of Clinical Medicine. 2020; 9(11):3738. https://doi.org/10.3390/jcm9113738

Chicago/Turabian Style

Novakova, Elena, Nina Kotlebova, Anezka Gryndlerova, Martin Novak, Michala Vladarova, Mark Wilcox, Ed Kuijper, and Marcela Krutova. 2020. "An Outbreak of Clostridium (Clostridioides) difficile Infections within an Acute and Long-Term Care Wards Due to Moxifloxacin-Resistant PCR Ribotype 176 Genotyped as PCR Ribotype 027 by a Commercial Assay" Journal of Clinical Medicine 9, no. 11: 3738. https://doi.org/10.3390/jcm9113738

APA Style

Novakova, E., Kotlebova, N., Gryndlerova, A., Novak, M., Vladarova, M., Wilcox, M., Kuijper, E., & Krutova, M. (2020). An Outbreak of Clostridium (Clostridioides) difficile Infections within an Acute and Long-Term Care Wards Due to Moxifloxacin-Resistant PCR Ribotype 176 Genotyped as PCR Ribotype 027 by a Commercial Assay. Journal of Clinical Medicine, 9(11), 3738. https://doi.org/10.3390/jcm9113738

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An Outbreak of Clostridium (Clostridioides) difficile Infections within an Acute and Long-Term Care Wards Due to Moxifloxacin-Resistant PCR Ribotype 176 Genotyped as PCR Ribotype 027 by a Commercial Assay

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