title: Characterization of swine isolates of Clostridium difficile in Spain: a potential source of epidemic multidrug resistant strains?
abstract: Clostridium difficile is an emerging pathogen for humans and animals and there is concern about the possibility that livestock might serve as a reservoir of epidemic strains. In Spain, ribotype 078 is one of the most prevalent in human episodes of C. difficile infection, but the distribution of this and other ribotypes in animals is yet unknown. We present the first report on the ribotype distribution and antimicrobial susceptibility of C. difficile in swine in Spain. A total of 144 isolates were PCR ribotyped, and their MIC values for 13 antimicrobial agents were determined using the Etest. Toxins A and B production was assessed using a commercial immunoassay and, in the case of toxin B, a specific cytotoxicity test. Our results show a high prevalence of the toxigenic 078 ribotype (94.4%) and multidrug resistance (49.3%) among the studied isolates. A minority of isolates (5.6%) belonged to a mostly non-toxinogenic ribotype. All isolates were resistant to the fluoroquinolone ciprofloxacin, but susceptible to daptomycin, linezolid, meropenem, rifampicin, teicoplanin, tigecycline, metronidazole and vancomycin. Resistance to clindamycin, ertapenem, erythromycin and moxifloxacin was common (≥27.8% in all cases). Resistance rates for the different antibiotics tested were in all cases independent from the ribotype of isolates and the host's condition (diarrheic or non-diarrheic), but erythromycin and moxifloxacin resistance was associated with the geographic origin of isolates. Metronidazole heteroresistance was found among animal isolates of C. difficile. Our results highlight the role of livestock as a potential source of epidemic multidrug resistant strains in Spain.
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain. mtpelaez@gmail.com
authors.forename: Teresa
authors.initials: T
authors.lastname: Peláez
authors.forename: Luis
authors.initials: L
authors.lastname: Alcalá
authors.forename: José L
authors.initials: JL
authors.lastname: Blanco
authors.forename: Sergio
authors.initials: S
authors.lastname: Álvarez-Pérez
authors.forename: Mercedes
authors.initials: M
authors.lastname: Marín
authors.forename: Adoración
authors.initials: A
authors.lastname: Martín-López
authors.forename: Pilar
authors.initials: P
authors.lastname: Catalán
authors.forename: Elena
authors.initials: E
authors.lastname: Reigadas
authors.forename: Marta E
authors.initials: ME
authors.lastname: García
authors.forename: Emilio
authors.initials: E
authors.lastname: Bouza
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016360:Clostridioides difficile / Q000235:genetics / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000662:veterinary*; D004197:Disease Reservoirs; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics*; D006801:Humans; D015995:Prevalence; D021521:Ribotyping; D013030:Spain / Q000453:epidemiology; D013552:Swine / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Clostridium difficile; Multidrug resistance; Ribotypes; Swine; Toxins