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The emergence of Clostridium difficile PCR-ribotype 001 in Slovakia

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Abstract

Purpose

The purpose of this study was to determine the incidence of Clostridium difficile infections (CDI) and to characterise the isolates in 14 departments of ten academic hospitals in Slovakia.

Methods

During a one-month study (September 2012) all unformed stool samples were investigated using a rapid test to detect the presence of GDH and toxins A/B. Positive samples were cultured anaerobically and C. difficile isolates were characterised by ribotyping, multiple-locus variable-number tandem repeats analysis, and gyrA, rpoB and ermB investigation.

Results

A total of 194 unformed stool samples were investigated and 38 (19.6 %) had a positive rapid test. Of 38 samples, 27 revealed a positive result for GDH and free toxins A/B in the stool, and 11 samples only for the presence of GDH. The mean CDI incidence in 2012 was 5.2 cases per 10,000 patient bed-days. Twenty C. difficile isolates were available for molecular analysis; seventeen belonged to PCR-ribotype 001 (85 %) whereas the remaining three isolates were identified as PCR-ribotypes 017, 078 and 449. MLVA of the PCR-ribotype 001 isolates identified two clonal complexes and a close genetic relatedness between isolates from six different hospitals. Molecular analysis of antibiotic-resistance determinants revealed the presence of ermB gene encoding resistance to the MLSB group of antibiotics in 90 % of isolates, and Thr82Ile amino acid substitution in the gyrA gene associated with resistance to fluoroquinolones in 85 % of isolates.

Conclusions

We conclude that C. difficile PCR-ribotype 001 is the predominant PCR-ribotype in Slovakia with a strong potential for clonal spread and development of multidrug resistance.

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Acknowledgments

We would like to thank ECDIS-net and the European Study Group of Clostridium difficile infections (ESGCD, ESCMID) for their professional support.

We would like to thank Dr. James Partridge for proofreading the text.

Ethical statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

For this type of study formal consent was not required.

Funding

Supported by the Ministry of Health, Czech Republic Internal Grant Agency NT/14209-3 and MH CZ – DRO, University Hospital Motol, Prague, Czech Republic 00064203.

Conflict of interest

The authors declare that they have no competing interests.

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Authors and Affiliations

  1. Department of Medical Microbiology, Charles University, 2nd Faculty of Medicine and University Hospital Motol, V Uvalu 84, Prague 5, 150 06, Czech Republic

    O. Nyc, M. Krutova & J. Matejkova

  2. DNA Laboratory, Department of Paediatric Neurology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic

    M. Krutova

  3. Department of Medical Microbiology, Faculty Hospital Nitra, Nitra, Slovak Republic

    A. Liskova

  4. Department of Internal Medicine, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic

    J. Drabek

  5. Department of Medical Microbiology, Leiden University Medical Centre, Leiden, Netherlands

    E. J. Kuijper

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  1. O. Nyc
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  2. M. Krutova
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Correspondence to M. Krutova.

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Nyc, O., Krutova, M., Liskova, A. et al. The emergence of Clostridium difficile PCR-ribotype 001 in Slovakia. Eur J Clin Microbiol Infect Dis 34, 1701–1708 (2015). https://doi.org/10.1007/s10096-015-2407-9

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