Multidrug-resistant North American pulsotype 2 Clostridium difficile was the predominant toxigenic hospital-acquired strain in the province of Manitoba, Canada, in 2006-2007.
The objective of the current study was to determine whether the antimicrobial susceptibility profile or genotype of hospital-acquired isolates of Clostridium difficile differed from isolates causing community-acquired disease. Five hundred diarrhoeal stool samples (one >2 ml sample per patient) from patients across Manitoba, Canada, in 2006-2007 that were reported as C. difficile toxin positive were cultured, resulting in 432 isolates of toxin-positive C. difficile for analysis. Of these 432 isolates, acquisition status could be determined for 235 (54.4%); 182 (77.4%) isolates were hospital acquired and 53 (22.6%) were community acquired. North American pulsotype (NAP) designations based on SmaI PFGE could be defined for 52.3% of the 432 isolates, with NAP2 (n=122) being the most common. Ninety-one per cent (71/78) of NAP2 isolates were recovered from patients with hospital-acquired C. difficile disease. Other NAP types and isolates with non-NAP-type PFGE patterns were less frequently associated with hospital-acquired disease. Community-acquired disease (35.3% of isolates) was associated with a wide variety of NAP types. NAP2 isolates were homogeneous (85.5% had SmaI PFGE pattern 0003) and demonstrated low susceptibility to moxifloxacin (6.6%) and clindamycin (1.6%) compared with non-NAP2 isolates (64.1-93.2% moxifloxacin susceptible; 14.1-28.2% clindamycin susceptible). All isolates of C. difficile in Manitoba were susceptible to metronidazole, piperacillin-tazobactam, amoxicillin-clavulanate and meropenem. NAP2 isolates of toxigenic C. difficile were approximately three times more common than NAP1 isolates (28.2 vs 9.1%) in Manitoba in 2006-2007, and these isolates demonstrated high levels of clonality and multidrug resistance, and were associated with hospital acquisition.
Diagnostic Services of Manitoba, Winnipeg, MB, Canada.|Department of Medical Microbiology, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada.
James A
JA
Karlowsky
Department of Medical Microbiology, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada.
George G
GG
Zhanel
Department of Community Health Services, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada.|Department of Medical Microbiology, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada.
Greg W
GW
Hammond
Department of Medical Microbiology, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada.
Ethan
E
Rubinstein
Cadham Provincial Laboratory, Winnipeg, MB, Canada.|Department of Medical Microbiology, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada.
John
J
Wylie
National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada.
Tim
T
Du
National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada.|Department of Medical Microbiology, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada.
Michael R
MR
Mulvey
Diagnostic Services of Manitoba, Winnipeg, MB, Canada.|Department of Medical Microbiology, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada.
Michelle J
MJ
Alfa
D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001427:Bacterial Toxins / Q000378:metabolism; D016360:Clostridioides difficile / Q000145:classification* / Q000235:genetics* / Q000302:isolation & purification; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology*; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D006801:Humans; D008350:Manitoba / Q000453:epidemiology; D008826:Microbial Sensitivity Tests; D017720:Molecular Epidemiology; D058889:Molecular Typing; D051316:Wiskott-Aldrich Syndrome Protein
D000900:Anti-Bacterial Agents; D001427:Bacterial Toxins; C495767:WAS protein, human; D051316:Wiskott-Aldrich Syndrome Protein