Clostridium difficile ribotypes in Austria: a multicenter, hospital-based survey

Area of Science:

• Infectious Diseases
• Microbiology
• Epidemiology

Background:

• Clostridium difficile infection (CDI) is a significant cause of healthcare-associated infections, particularly in elderly populations.
• The epidemiology and antimicrobial resistance patterns of CDI can vary geographically and by circulating bacterial strains.
• PCR-ribotyping is a key method for characterizing C. difficile strains and understanding their prevalence.

Purpose of the Study:

• To survey the prevalence of different Clostridium difficile PCR-ribotypes in Austrian hospitals.
• To investigate the association between specific ribotypes and severe CDI outcomes.
• To assess the in vitro susceptibility of C. difficile isolates to antibiotics, particularly fluoroquinolones.

Main Methods:

• Prospective, noninterventional survey of C. difficile positive patients across 18 Austrian hospitals.
• Collection and PCR-ribotyping of stool samples or C. difficile isolates from 171 eligible patients.
• In vitro susceptibility testing of C. difficile isolates, with a focus on fluoroquinolone resistance.

Main Results:

• The five most prevalent PCR-ribotypes were 027 (20%), 014 (15.8%), 053 (10.5%), 078 (5.3%), and 002 (4.7%).
• Severe CDI outcomes were associated with ribotype 053 (PR: 3.04), not with hypervirulent ribotypes 027 or 078.
• All isolates of ribotypes 027 and 053 demonstrated in vitro resistance to moxifloxacin.

Conclusions:

• Ribotype 053 is associated with severe Clostridium difficile infection outcomes in Austria.
• The prevalence of fluoroquinolone-resistant C. difficile strains, including ribotypes 027 and 053, is a significant concern.
• Healthcare use of fluoroquinolones may contribute to the spread of these resistant C. difficile clones.