title: Molecular characterization and antimicrobial susceptibility patterns of Clostridium difficile strains isolated from hospitals in south-east Scotland.
abstract: Clostridium difficile isolates (n=149) collected in south-east Scotland between August and October 2005 were typed by four different methods and their susceptibility to seven different antibiotics was determined. The aims were to define the types of strain occurring in this region and to determine whether there were any clonal relationships among them with respect to genotype and antibiotic resistance pattern. Ribotyping revealed that 001 was the most common type (n=113, 75.8 %), followed by ribotype 106 (12 isolates, 8.1 %). The majority of the isolates (96.6 %, n=144) were of toxinotype 0, with two toxinotype V isolates and single isolates of toxinotypes I, IV and XIII. PCR and restriction analysis of the fliC gene from 147 isolates gave two restriction patterns: 145 of pattern VII and two of pattern I. Binary toxin genes were detected in only three isolates: two isolates of ribotype 126, toxinotype V, and one isolate of ribotype 023, toxinotype IV. S-types showed more variation, with 64.5 % (n=40) of the common S-type (4,939) and 21 % (n=13) of S-type 4,741, with six other S-types (one to three isolates each). All ribotype 001 isolates were of the same S-type (4,939), with three isolates of other ribotypes being this S-type. No resistance was found to metronidazole or vancomycin, with resistance to tetracycline only found in 4.3 % of the isolates. A high proportion of isolates were resistant to clindamycin (62.9 %), moxifloxacin, ceftriaxone (both 87.1 %) and erythromycin (94.8 %). Resistance to three antibiotics (erythromycin, clindamycin and ceftriaxone) was seen in 66 isolates, with erythromycin, ceftriaxone and moxifloxacin resistance seen in 96 isolates. Resistance to all four of these antibiotics was found in 62 isolates and resistance to five (the above plus tetracycline) in one isolate: a ribotype 001, toxinotype 0 strain. Whilst ribotype 001 was the most commonly encountered type, there was no evidence of clonal relationships when all other typing and antibiotic resistance patterns were taken into account.
authors.affiliation: Medical Microbiology, Centre for Infectious Diseases, University of Edinburgh College of Medicine and Veterinary Medicine, The Chancellors Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK.
authors.forename: Esvet
authors.initials: E
authors.lastname: Mutlu
authors.affiliation: Medical Microbiology, Centre for Infectious Diseases, University of Edinburgh College of Medicine and Veterinary Medicine, The Chancellors Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK.
authors.forename: Allison J
authors.initials: AJ
authors.lastname: Wroe
authors.affiliation: Medical Microbiology, Centre for Infectious Diseases, University of Edinburgh College of Medicine and Veterinary Medicine, The Chancellors Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK.
authors.forename: Karla
authors.initials: K
authors.lastname: Sanchez-Hurtado
authors.affiliation: Anaerobe Reference Laboratory, NPHS Microbiology Cardiff, University Hospital of Wales, Cardiff, UK.
authors.forename: Jon S
authors.initials: JS
authors.lastname: Brazier
authors.affiliation: Medical Microbiology, Centre for Infectious Diseases, University of Edinburgh College of Medicine and Veterinary Medicine, The Chancellors Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK.
authors.forename: Ian R
authors.initials: IR
authors.lastname: Poxton
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001426:Bacterial Proteins / Q000145:classification / Q000235:genetics / Q000378:metabolism; D001427:Bacterial Toxins / Q000235:genetics / Q000378:metabolism; D015373:Bacterial Typing Techniques; D016360:Clostridioides difficile / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D024881:Drug Resistance, Bacterial; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000382:microbiology; D004768:Enterotoxins / Q000235:genetics / Q000378:metabolism; D005408:Flagellin / Q000235:genetics; D005838:Genotype; D006761:Hospitals; D006801:Humans; D008562:Membrane Glycoproteins / Q000145:classification; D008826:Microbial Sensitivity Tests; D012150:Polymorphism, Restriction Fragment Length; D021521:Ribotyping; D012606:Scotland / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001427:Bacterial Toxins; D004768:Enterotoxins; D008562:Membrane Glycoproteins; C055764:S-layer proteins; C041348:tcdA protein, Clostridium difficile; C031815:toxB protein, Clostridium difficile; D005408:Flagellin