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Increasing incidence of Clostridium difficile ribotype 001 associated with severe course of the infection and previous fluoroquinolone use in the Czech Republic, 2015

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Abstract

The aim of the study was to provide an update on the epidemiology of C. difficile infection (CDI) in a representative number of hospitals within the Czech Republic in 2015. In 2015, twenty-eight Czech hospitals were invited to participate in a CDI study. Laboratories sent the first 20 consecutive C. difficile isolates for characterization by capillary-electrophoresis (CE) ribotyping and the presence of toxin genes and collected patient data on previous hospitalization, antibiotic treatment, the number of CDI episodes and the course of CDI. The mean incidence of CDI was 5.2 [95% CI 4.2–6.2] cases per 10,000 patient-bed days in 27 hospitals in 2015. Of 490 C. difficile isolates, the prevalent PCR ribotypes (RTs) were 001 (n = 164, 33.5%) and 176 (n = 125, 25.5%) followed by 014 (n = 37, 7.6%), 012 (n = 17, 3.5%), 020 (n = 16, 3.3%), 017 (n = 14, 2.9%) and 002 (n = 11, 2.2%). A severe course of CDI was reported in 104 cases (21.2%) with significant association with RT001 infection (p = 0.03). CDI recurrence was 10.8% (n = 53). The previous use of fluoroquinolones was associated with RTs 001 and 176 CDIs (p = 0.046 and p = 0.041). We observed a persistence of RTs 001 and 176 CDIs in the Czech Republic that was associated with the previous use of fluoroquinolones. This highlights the need for a reduction in fluoroquinolone use in Czech hospital settings.

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Acknowledgements

We would like to thank the ESCMID Study Group for Clostridium difficile (ESGCD) for their professional support.

The members of the study group

Renata Tejkalova, Department of Medical Microbiology, Faculty of Medicine, Masaryk University and St. Anne’s University Hospital, Brno, Czech Republic; Katarina Petrlova, Department of Medical Microbiology, Hospital Bulovka, Prague, Czech Republic; Marketa Hanslianova, Department of Medical Microbiology, University Hospital Brno, Czech Republic; Magda Balejova, Department of Medical Microbiology, Hospital Ceske Budejovice, Czech Republic; Vera Paleckova, Department of Medical Microbiology Thomayer’s University Hospital, Prague, Czech Republic; Antonin Melichar, Department Hospital Laboratory, Hospital Havlickuv Brod, Czech Republic; Lenka Ryskova, Department of Clinical Microbiology, University Hospital Hradec Kralove, Czech Republic; Dana Nemcova, Department of Clinical Microbiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; Denisa Vesela, Department of Medical Microbiology, Hospital Jindrichuv Hradec, Czech Republic; Miloslava Rumlerova, Department of Medical Microbiology, Hospital Kladno, Czech Republic; Lenka Havlinova, Department of Medical Microbiology and Immunology, Hospital Liberec, Czech Republic; Otakar Nyc, Department of Medical Microbiology, 2nd Faculty of Medicine, Charles University in Prague and University Hospital Motol, Czech Republic; Dana Zamazalova, Department of Clinical Microbiology, Hospital Nove Mesto na Morave, Czech Republic; Katerina Laskafeldova, Department of Clinical Microbiology, AGEL Laboratories Inc., Novy Jicin, Czech Republic; Iva Vagnerova, Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Czech Republic; Pavlina Uhorskai, Department of Microbiology Havirov, Public Health Institute Ostrava, Czech Republic; Lenka Geigerova, Department of Microbiology, Faculty of Medicine and University Hospital Plzen, Charles University in Prague, Plzen, Czech Republic; Petr Jezek, Department of Medical Microbiology, Hospital Pribram, Czech Republic; Marketa Hajna, Department of Clinical Microbiology, Hospital Strakonice, Czech Republic; Alice Kucharova, Department of Medical Microbiology, Hospital Tabor, Czech Republic; Natasa Bartonikova, Department of Medical Microbiology, Tomas Bata’s Hospital Zlin, Czech Republic; Martina Curdova, Department of Clinical Microbiology, Military University Hospital Prague, Czech Republic; Vaclav Vanis, Department of Clinical Microbiology, Hospital Na Homolce, Prague, Czech Republic; Helena Skacani, Department of Clinical Microbiology, Hospital Jihlava, Czech Republic.

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Authors and Affiliations

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

    M. Krutova, J. Matejkova, P. Drevinek & O. Nyc

  2. Leiden University Medical Centre, Leiden, the Netherlands

    E. J. Kuijper

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  1. M. Krutova
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  2. J. Matejkova
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  4. E. J. Kuijper
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Consortia

on behalf of the study group

  • Renata Tejkalova
  • , Katarina Petrlova
  • , Marketa Hanslianova
  • , Magda Balejova
  • , Vera Paleckova
  • , Antonin Melichar
  • , Lenka Ryskova
  • , Dana Nemcova
  • , Denisa Vesela
  • , Miloslava Rumlerova
  • , Lenka Havlinova
  • , Otakar Nyc
  • , Dana Zamazalova
  • , Katerina Laskafeldova
  • , Iva Vagnerova
  • , Pavlina Uhorskai
  • , Lenka Geigerova
  • , Petr Jezek
  • , Marketa Hajna
  • , Alice Kucharova
  • , Natasa Bartonikova
  • , Martina Curdova
  • , Vaclav Vanis
  •  & Helena Skacani

Corresponding author

Correspondence to M. Krutova.

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Funding

Supported by MH CZ – DRO, Motol University Hospital, Prague, Czech Republic 00064203 and ECDC-framework service contract ECDC/2016/016 (OJ/05/11/2015-PROC/2015/029).

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

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.

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For this type of study formal consent was not required.

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Krutova, M., Matejkova, J., Drevinek, P. et al. Increasing incidence of Clostridium difficile ribotype 001 associated with severe course of the infection and previous fluoroquinolone use in the Czech Republic, 2015. Eur J Clin Microbiol Infect Dis 36, 2251–2258 (2017). https://doi.org/10.1007/s10096-017-3055-z

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