Differences in the Molecular Epidemiology and Antibiotic Susceptibility of Clostridium difficile Isolates in Pediatric and Adult Patients.
The rising incidence of Clostridium difficile infections (CDIs) in adults is partly related to the global spread of fluoroquinolone-resistant strains, namely, BI/NAP1/027. Although CDIs are also increasingly diagnosed in children, BI/NAP1/027 is relatively uncommon in children. Little is known about the antibiotic susceptibility of pediatric CDI isolates. C. difficile was cultured from tcdB-positive stools collected from children diagnosed with CDI between December 2012 and December 2013 at an academic children's hospital. CDI isolates were grouped by restriction endonuclease analysis (REA). MICs were measured by agar dilution method for 7 antibiotics. Susceptibility breakpoints were based on guidelines from CLSI and/or the European Committee on Antimicrobial Susceptibility Testing (EUCAST). MICs and REA groupings of C. difficile isolates from 74 adult patients (29 isolates underwent REA) from a temporally and geographically similar adult cohort were compared to those of pediatric isolates. Among 122 pediatric and 74 adult isolates, respectively, the rates of resistance were as follows: metronidazole, 0% and 0%; vancomycin, 0% and 8% (P = 0.003); rifaximin, 1.6% and 6.7% (P = 0.11); clindamycin, 18.9% and 25.3% (P = 0.29); and moxifloxacin, 2.5% and 36% (P = <0.0001). Only 1 of 122 (0.8%) BI/NAP1/027 isolates was identified among the children, compared to 9 of 29 (31%) isolates identified among the adults (P = <0.0001). The 3 moxifloxacin-resistant pediatric isolates were of REA groups BI and CF and a nonspecific group. The 2 rifaximin-resistant pediatric isolates were of REA groups DH and Y. The 21 clindamycin-resistant pediatric isolates were distributed among 9 REA groups (groups A, CF, DH, G, L, M, and Y and 2 unique nonspecific REA groups). These data suggest that a diverse array of relatively antibiotic-susceptible C. difficile strains predominate in a cohort of children with CDI compared to adults.
Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA Larry-Kociolek@northwestern.edu.
Larry K
LK
Kociolek
Hines VA Hospital, Hines, Illinois, USA Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA.
Dale N
DN
Gerding
Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA.
James R
JR
Osmolski
Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Sameer J
SJ
Patel
Tufts University School of Medicine, Boston, Massachusetts, USA Tufts Medical Center, Boston, Massachusetts, USA.
David R
DR
Snydman
Tufts Medical Center, Boston, Massachusetts, USA.
Laura A
LA
McDermott
Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA.
David W
DW
Hecht
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015373:Bacterial Typing Techniques / Q000379:methods; D016360:Clostridioides difficile / Q000187:drug effects* / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000188:drug therapy*; D024881:Drug Resistance, Bacterial / Q000187:drug effects; D005243:Feces / Q000382:microbiology; D006801:Humans; D007223:Infant; D008826:Microbial Sensitivity Tests / Q000379:methods; D017720:Molecular Epidemiology / Q000379:methods; D000091402:Prohibitins; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents; C000717331:PHB2 protein, human; D000091402:Prohibitins