title: Clostridium difficile infection among immunocompromised patients in Rio de Janeiro, Brazil and detection of moxifloxacin resistance in a ribotype 014 strain.
abstract: Clostridium difficile is a Gram-positive spore forming anaerobic bacterium, often associated with nosocomial diarrhea and pseudomembranous colitis. The acquisition of this organism occurs primarily in hospitals through accidental ingestion of spores, and its establishment and proliferation in the colon results from the removal of members of the normal intestinal flora during or after antibiotic therapy. In this study, stool samples from patients admitted to the University Hospital Clementino Fraga Filho (HUCCF/UFRJ) were screened for C. difficile toxins with an ELISA test and cultured with standard techniques for C. difficile isolation. A total of 74 stool samples were collected from patients undergoing antibiotic therapy between August 2009 and November 2010, only two (2.7%) were positive in the ELISA test and culture. A third isolate was obtained from a negative ELISA test sample. All cases of CDI were identified in patients with acute lymphoid or myeloid leukemia. Genotypic and phenotypic characterization showed that all strains carried toxins A and B genes, and belonged to PCR-ribotypes 014, 043 and 046. The isolated strains were sensitive to metronidazole and vancomycin, and resistant to ciprofloxacin and levofloxacin. Resistance to moxifloxacin, was present in the strain from PCR-ribotype 014, that showed an amino acid substitution in gyrB gene (Asp 426 → Asn). This is the first time that this mutation in a PCR-ribotype 014 strain has been described in Brazil.
authors.affiliation: Laboratório de Biologia de Anaeróbios, Departamento de Microbiologia Médica, Instituto de Microbiologia Prof. Paulo de Góes, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho 373, CEP 21941-900 Rio de Janeiro, RJ, Brazil. Electronic address: daniangstsecco@gmail.com.
authors.forename: Danielle Angst
authors.initials: DA
authors.lastname: Secco
authors.affiliation: Laboratório de Zoonoses Bacterianas, Instituto Oswaldo Cruz-Fiocruz, Rio de Janeiro, RJ, Brazil.
authors.forename: Ilana Teruszkin
authors.initials: IT
authors.lastname: Balassiano
authors.affiliation: Laboratório de Biologia de Anaeróbios, Departamento de Microbiologia Médica, Instituto de Microbiologia Prof. Paulo de Góes, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho 373, CEP 21941-900 Rio de Janeiro, RJ, Brazil.
authors.forename: Renata Ferreira
authors.initials: RF
authors.lastname: Boente
authors.affiliation: Laboratório de Biologia de Anaeróbios, Departamento de Microbiologia Médica, Instituto de Microbiologia Prof. Paulo de Góes, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho 373, CEP 21941-900 Rio de Janeiro, RJ, Brazil.
authors.forename: Karla Rodrigues
authors.initials: KR
authors.lastname: Miranda
authors.affiliation: Anaerobe Reference Unit, Public Health Wales Microbiology, University Hospital of Wales, Cardiff, Wales, United Kingdom.
authors.forename: Jon
authors.initials: J
authors.lastname: Brazier
authors.affiliation: Anaerobe Reference Unit, Public Health Wales Microbiology, University Hospital of Wales, Cardiff, Wales, United Kingdom.
authors.forename: Val
authors.initials: V
authors.lastname: Hall
authors.affiliation: Laboratório de Biologia de Anaeróbios, Departamento de Microbiologia Médica, Instituto de Microbiologia Prof. Paulo de Góes, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho 373, CEP 21941-900 Rio de Janeiro, RJ, Brazil.
authors.forename: Joaquim
authors.initials: J
authors.lastname: dos Santos-Filho
authors.affiliation: Laboratório de Biologia de Anaeróbios, Departamento de Microbiologia Médica, Instituto de Microbiologia Prof. Paulo de Góes, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho 373, CEP 21941-900 Rio de Janeiro, RJ, Brazil.
authors.forename: Leandro Araujo
authors.initials: LA
authors.lastname: Lobo
authors.affiliation: Coordenação de Controle de Infecções Hospitalares - HUCCF/UFRJ, Rio de Janeiro, RJ, Brazil.
authors.forename: Simone Aranha
authors.initials: SA
authors.lastname: Nouér
authors.affiliation: Laboratório de Biologia de Anaeróbios, Departamento de Microbiologia Médica, Instituto de Microbiologia Prof. Paulo de Góes, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho 373, CEP 21941-900 Rio de Janeiro, RJ, Brazil.
authors.forename: Regina Maria Cavalcanti Pilotto
authors.initials: RM
authors.lastname: Domingues
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001427:Bacterial Toxins / Q000032:analysis; D001938:Brazil; D016360:Clostridioides difficile / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000382:microbiology*; D003428:Cross Infection / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D004797:Enzyme-Linked Immunosorbent Assay; D005243:Feces / Q000382:microbiology*; D005260:Female; D024841:Fluoroquinolones / Q000494:pharmacology*; D019337:Hematologic Neoplasms / Q000150:complications; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D000077266:Moxifloxacin; D021521:Ribotyping
chemical_list: D000900:Anti-Bacterial Agents; D001427:Bacterial Toxins; D024841:Fluoroquinolones; D000077266:Moxifloxacin
keywords: CDI; Clostridium difficile; Moxifloxacin resistance; Nosocomial infection