title: A national survey of the molecular epidemiology of Clostridium difficile in Israel: the dissemination of the ribotype 027 strain with reduced susceptibility to vancomycin and metronidazole.
abstract: Our goals were to study the molecular epidemiology and antimicrobial susceptibilities of C. difficile strains in Israel. Microbiology laboratories serving 6 general hospitals (GH) and 10 long-term care facilities (LTCF) were asked to submit all stool samples in January-February 2014 that tested positive for C. difficile. Toxigenic C. difficile isolates were recovered in 208 out of 217 samples (95.8%), of which 50 (23.6%) were from LTCFs. Ribotype 027 was the most common type overall, identified in 65 samples (31.8%), and was the predominant strain in the 3 GHs with the highest incidence of C. difficile infections. Other common strains were slpA types cr-02 (n = 45) and hr-02 (n = 18). The proportions of vancomycin and metronidazole MIC values >2mg/L were high in ribotype 027 (87.7% and 44.6%, respectively) and slpA-cr-02 strains (88.8% and 17.8%, respectively). This study demonstrates that the ribotype 027 strain has disseminated across Israel and is now the most common strain.
authors.affiliation: National Center of Infection Control, Ministry of Health, Tel Aviv, Israel. Electronic address: amosa@tlvmc.gov.il.
authors.forename: Amos
authors.initials: A
authors.lastname: Adler
authors.affiliation: National Center of Infection Control, Ministry of Health, Tel Aviv, Israel.
authors.forename: Tamar
authors.initials: T
authors.lastname: Miller-Roll
authors.affiliation: Clinical Microbiology Laboratory, Kaplan Medical Center, Rehovot, Israel.
authors.forename: Rita
authors.initials: R
authors.lastname: Bradenstein
authors.affiliation: Clinical Microbiology Laboratory, Hadassah Medical Center, Jerusalem, Israel.
authors.forename: Colin
authors.initials: C
authors.lastname: Block
authors.affiliation: Clinical Microbiology Laboratory, Bnei-Zion Medical Center, Haifa, Israel.
authors.forename: Bracha
authors.initials: B
authors.lastname: Mendelson
authors.affiliation: Clinical Microbiology Laboratory, Maccabi Health Services, Rehovot, Israel.
authors.forename: Miriam
authors.initials: M
authors.lastname: Parizade
authors.affiliation: Clinical Microbiology Laboratory, Meir Medical Center, Kfar Saba, Israel.
authors.forename: Yossi
authors.initials: Y
authors.lastname: Paitan
authors.affiliation: Clinical Microbiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Schwartz
authors.affiliation: Clinical Microbiology Laboratory, Soroka Medical Center, Be'er-Sheba, Israel.
authors.forename: Nehama
authors.initials: N
authors.lastname: Peled
authors.affiliation: National Center of Infection Control, Ministry of Health, Tel Aviv, Israel.
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Carmeli
authors.affiliation: National Center of Infection Control, Ministry of Health, Tel Aviv, Israel.
authors.forename: Mitchell J
authors.initials: MJ
authors.lastname: Schwaber
mesh_terms: D000890:Anti-Infective Agents / Q000494:pharmacology*; D016360:Clostridioides difficile / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D008795:Metronidazole / Q000494:pharmacology*; D008826:Microbial Sensitivity Tests; D017720:Molecular Epidemiology; D021521:Ribotyping; D014640:Vancomycin / Q000494:pharmacology*
chemical_list: D000890:Anti-Infective Agents; D008795:Metronidazole; D014640:Vancomycin
keywords: Clostridium difficile; Epidemic clone; Metronidazole; Vancomycin