title: Antibiotic susceptibility of Clostridium difficile isolates from adult patients at two Jamaican hospitals. Clinical and epidemiological implications.
abstract: The susceptibility of 39 toxin producing Clostridium difficile isolates from stools of hospitalized patients was determined, by disc diffusion, to six antibiotics. All but one isolate (toxin A negative) produced toxin A and toxin B. A wide variation in susceptibility to clindamycin, tetracycline and chloramphenicol was noted. Erythromycin and cotrimoxazole showed a clear-cut discrimination in resistance and susceptibility, while all isolates were sensitive to vancomycin. Erythromycin sensitive isolates demonstrated a significant association with diarrhoea (60.9%, 14/23, p < 0.001). These strains were predominantly found at the University Hospital of the West Indies (UHWI, 94.1%, 16/17). Strains resistant to erythromycin and clindamycin together were commonly found at the National Chest Hospital (NCH, 68.2%, 15/22). All erythromycin sensitive strains found at the NCH were from patients transferred to that hospital. These findings suggest that there is a common strain of C difficile (erythromycin resistant) at the NCH different from that found at the UHWI; the resistant pattern seen with isolates from the NCH was typical of toxigenic serogroup C strain and could be typed by the the disc diffusion method. Patients at the NCH who were colonized with either of the two strains of C difficile were likely to get diarrhoea, once there was suppression of the normal microflora by antibiotics and colonic overgrowth with C difficile.
authors.affiliation: Departments of Microbiology and Medicine, University of the West Indies, Kingston 7, Jamaica. ohes@cwjamaica.com
authors.forename: O D
authors.initials: OD
authors.lastname: Heslop
authors.forename: S D
authors.initials: SD
authors.lastname: King
authors.forename: P N
authors.initials: PN
authors.lastname: Levett
authors.forename: E N
authors.initials: EN
authors.lastname: Barton
authors.forename: J
authors.initials: J
authors.lastname: Wynter
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001426:Bacterial Proteins; D001427:Bacterial Toxins / Q000096:biosynthesis; D016360:Clostridioides difficile / Q000187:drug effects* / Q000378:metabolism; D003967:Diarrhea / Q000209:etiology*; D004761:Enterocolitis, Pseudomembranous / Q000150:complications* / Q000382:microbiology; D004768:Enterotoxins / Q000096:biosynthesis; D005260:Female; D006801:Humans; D007563:Jamaica; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001427:Bacterial Toxins; D004768:Enterotoxins; C041348:tcdA protein, Clostridium difficile; C031815:toxB protein, Clostridium difficile