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Antimicrobial susceptibility profiles of human and piglet Clostridium difficile PCR-ribotype 078
Elisabeth C Keessen1, Marjolein Pm Hensgens2, Patrizia Spigaglia3
1Institute for Risk Assessment Sciences, Utrecht University, PO Box 80175, Utrecht 3508 TD, the Netherlands.
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.
Insights
Emerging Clostridium difficile PCR-ribotype 078 shows similar antimicrobial resistance in humans and pigs. Fluoroquinolone use is linked to resistance, potentially driving the spread of this C. difficile type.
Area of Science:
- Microbiology
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Nosocomial Clostridium difficile infections (CDI) are a global concern, with emerging strains like PCR-ribotype 027 previously identified.
- An increasing incidence of C. difficile PCR-ribotype 078 has been observed in both human and porcine populations in Europe.
- Understanding the antimicrobial susceptibility and resistance mechanisms of this specific strain is crucial for infection control.
Purpose of the Study:
- To investigate the antimicrobial susceptibility patterns of human and porcine Clostridium difficile PCR-ribotype 078 isolates.
- To identify the mechanisms of resistance and their correlation with prior antimicrobial exposure.
- To assess the potential link between antimicrobial usage and the prevalence of C. difficile PCR-ribotype 078.
Main Methods:
- Antimicrobial susceptibility testing was performed on 49 human and 50 porcine C. difficile PCR-ribotype 078 isolates using EUCAST and CLSI guidelines.
- Eight different antimicrobial agents were tested, and resistance mechanisms, including specific gene presence and mutations, were investigated.
- Statistical analysis was used to correlate isolate resistance profiles with previous antimicrobial prescriptions in humans and pigs.
Main Results:
- Human and porcine C. difficile PCR-ribotype 078 isolates exhibited similar susceptibility patterns.
- High resistance rates were observed for ciprofloxacin (96%) and cefuroxim (96%), while susceptibility was high for amoxicillin (100%) and tetracycline (100%).
- Resistance to moxifloxacin and clindamycin was linked to gyr(A) mutations and erm(B) gene presence, respectively. Fluoroquinolone use was significantly associated with moxifloxacin-resistant isolates.
Conclusions:
- Clostridium difficile PCR-ribotype 078 demonstrates significant antimicrobial resistance, particularly to fluoroquinolones, in both human and porcine isolates.
- The genetic basis for resistance to specific antimicrobials has been identified.
- Increased fluoroquinolone usage may be a contributing factor to the spread of C. difficile PCR-ribotype 078.
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