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Antimicrobial susceptibility profiles of human and piglet Clostridium difficile PCR-ribotype 078

Elisabeth C Keessen2, Marjolein PM Hensgens1, Patrizia Spigaglia3, Fabrizio Barbanti3, Ingrid MJG Sanders1, Ed J Kuijper1* and Len JA Lipman2

Author Affiliations

1 Department of Medical Microbiology, Leiden University Medical Center, PO Box 9600, Leiden 2300 RC, the Netherlands

2 Institute for Risk Assessment Sciences, Utrecht University, PO Box 80175, Utrecht 3508 TD, the Netherlands

3 Department of Infectious, Parasitic and Immune-mediated Diseases, Instituto Superiore di Sanita’, Rome, Italy

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Antimicrobial Resistance and Infection Control 2013, 2:14  doi:10.1186/2047-2994-2-14

Published: 8 April 2013

Abstract

In the last decade, outbreaks of nosocomial Clostridium difficile infections (CDI) occurred worldwide. A new emerging type, PCR-ribotype 027, was the associated pathogen. Antimicrobial susceptibility profiles of this type were extensively investigated and used to partly explain its spread. In Europe, the incidence of C. difficile PCR-ribotype 078 recently increased in humans and piglets. Using recommendations of the European Committee on Antimicrobial Susceptibility Testing (EUCAST) and the Clinical and Laboratory Standards Institute (CLSI) we studied the antimicrobial susceptibility to eight antimicrobials, mechanisms of resistance and the relation with previously prescribed antimicrobials in human (n=49) and porcine (n=50) type 078 isolates. Human and porcine type 078 isolates showed similar antimicrobial susceptibility patterns for the antimicrobials tested. In total, 37% of the isolates were resistant to four or more antimicrobial agents. The majority of the human and porcine isolates were susceptible to amoxicillin (100%), tetracycline (100%) and clindamycin (96%) and resistant to ciprofloxacin (96%). More variation was found for resistance patterns to erythromycin (76% in human and 59% in porcine isolates), imipenem (29% in human and 50% in porcine isolates) and moxifloxacin (16% for both human and porcine isolates). MIC values of cefuroxim were high (MICs >256 mg/L) in 96% of the isolates. Resistance to moxifloxacin and clindamycin was associated with a gyr(A) mutation and the presence of the erm(B) gene, respectively. A large proportion (96%) of the erythromycin resistant isolates did not carry the erm(B) gene. The use of ciprofloxacin (humans) and enrofloxacin (pigs) was significantly associated with isolation of moxifloxacin resistant isolates. Increased fluoroquinolone use could have contributed to the spread of C. difficile type 078.