title: Occurrence of Clostridium difficile PCR-ribotype 027 and it's closely related PCR-ribotype 176 in hospitals in Poland in 2008-2010.
abstract: Since 2003, a rising incidence of Clostridium difficile infection (CDI) in North America and Europe has coincided with outbreaks of C. difficile PCR ribotype 027. This ribotype was not observed in Poland until 2008. In the period 2008-2010, outbreaks of antibiotic-associated diarrhoea occurred in three different hospitals in Poland. Of 30 C. difficile isolates available for microbiological characterisation, 17 (56%) were positive for binary toxin genes and belonged to PCR ribotype 027 (n = 7) and its closely related PCR ribotype 176 (n = 10). All 17 binary toxin-positive C. difficile strains demonstrated high-level resistance to fluoroquinolones (minimum inhibitory concentration (MIC) ≥ 32 mg/L), including ciprofloxacin, gatifloxacin, and moxifloxacin, as well as erythromycin and clindamycin (MIC ≥ 256 mg/L for both). Of 14 patients from whom clinical information was available, 50% had a severe form of CDI, defined by fever (>38.5 °C), decreased kidney function, and high leucocyte count. We conclude that outbreaks of CDI associated with hypervirulent strains belonging to PCR ribotypes 027 and 176 occurred in hospitals in Poland. Further studies evaluating the clinical impact of type 176 are urgently needed.
authors.affiliation: Department of Medical Microbiology, Medical University of Warsaw, 5 Chałubiński Street, 02-004 Warsaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Obuch-Woszczatyński
authors.affiliation: Department of Medical Microbiology, Medical University of Warsaw, 5 Chałubiński Street, 02-004 Warsaw, Poland.
authors.forename: Dominika
authors.initials: D
authors.lastname: Lachowicz
authors.affiliation: Department of Diagnostic Laboratory, Clinical Hospital of the Transfiguration, Poznań, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Schneider
authors.affiliation: Department of Diagnostic Laboratory, Clinical Hospital of the Transfiguration, Poznań, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Mól
authors.affiliation: Diagnostic Laboratory, Provincial Hospital in Płock, Poland.
authors.forename: Jolanta
authors.initials: J
authors.lastname: Pawłowska
authors.affiliation: Department of Internal Medicine and Cardiology, Infant Jesus Teaching Hospital in Warsaw, Medical University of Warsaw, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Ożdżeńska-Milke
authors.affiliation: Department of Internal Medicine and Cardiology, Infant Jesus Teaching Hospital in Warsaw, Medical University of Warsaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Pruszczyk
authors.affiliation: Department of Medical Microbiology, Medical University of Warsaw, 5 Chałubiński Street, 02-004 Warsaw, Poland.
authors.forename: Dorota
authors.initials: D
authors.lastname: Wultańska
authors.affiliation: Department of Medical Microbiology, Medical University of Warsaw, 5 Chałubiński Street, 02-004 Warsaw, Poland.
authors.forename: Grażyna
authors.initials: G
authors.lastname: Młynarczyk
authors.affiliation: Department of Medical Microbiology, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Celine
authors.initials: C
authors.lastname: Harmanus
authors.affiliation: Department of Medical Microbiology, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Ed J
authors.initials: EJ
authors.lastname: Kuijper
authors.affiliation: bioMérieux R&D Microbiology, La Balme Les Grottes, France.
authors.forename: Alex
authors.initials: A
authors.lastname: van Belkum
authors.affiliation: Department of Medical Microbiology, Medical University of Warsaw, 5 Chałubiński Street, 02-004 Warsaw, Poland. Electronic address: hanna.pituch@wum.edu.pl.
authors.forename: Hanna
authors.initials: H
authors.lastname: Pituch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001427:Bacterial Toxins / Q000235:genetics; D016360:Clostridioides difficile / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D017720:Molecular Epidemiology; D011044:Poland / Q000453:epidemiology; D016133:Polymerase Chain Reaction; D021521:Ribotyping
chemical_list: D000900:Anti-Bacterial Agents; D001427:Bacterial Toxins
keywords: Clostridium difficile infection; Outbreak; PCR ribotype 027; PCR ribotype 176