title: Two Clusters of Fluoroquinolone and Clindamycin-Resistant Clostridium difficile PCR Ribotype 001 Strain Recognized by Capillary Electrophoresis Ribotyping and Multilocus Variable Tandem Repeat Analysis.
abstract: OBJECTIVE
  To perform a retrospective analysis of the high occurrence of Clostridium difficile infection in the surgical department of a Czech tertiary care hospital and to identify weaknesses in C. difficile infection (CDI) prevention and control policies.
  
  
  METHODS
  Clinical and epidemiological data on eleven CDI cases were collected. C. difficile isolates were characterized by capillary electrophoresis ribotyping, multilocus variable tandem repeat analysis (MLVA), gyrA gene fragment sequencing, and erm(B) fragment PCR amplification. Antibiotic susceptibility to metronidazole, vancomycin, ciprofloxacin, moxifloxacin, and clindamycin was tested.
  
  
  RESULTS
  Eleven CDI cases were caused by C. difficile PCR ribotype 001 strains. These strains revealed two different MLVA profiles with 11 tandem repeat differences. All isolates were susceptible to metronidazole and vancomycin and resistant to ciprofloxacin (MIC ≥32 mg/L), moxifloxacin (MIC ≥32 mg/L), and clindamycin (MIC ≥256 mg/L). All isolates revealed amino acid substitution Thr82Ile, in the GyrA and were erm(B) negative.
  
  
  CONCLUSIONS
  Two fluoroquinolone and clindamycin-resistant C. difficile PCR ribotype 001 strain clusters occurred at one of the surgical departments of a tertiary care hospital. Ineffective decontamination with suboptimal concentration and time of exposure of sporicidal disinfectants may have resulted in C. difficile transmission.
authors.affiliation: 1 Department of Medical Microbiology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital , Praha, Czech Republic .
authors.forename: Otakar
authors.initials: O
authors.lastname: Nyc
authors.affiliation: 2 Department of Medical Microbiology, St. Anne's University Hospital, and Faculty of Medicine, Masaryk University , Brno, Czech Republic .
authors.forename: Renata
authors.initials: R
authors.lastname: Tejkalova
authors.affiliation: 3 2nd Department of Surgery, St. Anne's University Hospital, and Faculty of Medicine, Masaryk University , Brno, Czech Republic .
authors.forename: Zdenek
authors.initials: Z
authors.lastname: Kriz
authors.affiliation: 2 Department of Medical Microbiology, St. Anne's University Hospital, and Faculty of Medicine, Masaryk University , Brno, Czech Republic .
authors.forename: Filip
authors.initials: F
authors.lastname: Ruzicka
authors.affiliation: 3 2nd Department of Surgery, St. Anne's University Hospital, and Faculty of Medicine, Masaryk University , Brno, Czech Republic .
authors.forename: Lubos
authors.initials: L
authors.lastname: Kubicek
authors.affiliation: 1 Department of Medical Microbiology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital , Praha, Czech Republic .
authors.forename: Jana
authors.initials: J
authors.lastname: Matejkova
authors.affiliation: 4 Leiden University Medical Centre , Leiden, the Netherlands .
authors.forename: Ed
authors.initials: E
authors.lastname: Kuijper
authors.affiliation: 1 Department of Medical Microbiology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital , Praha, Czech Republic .|5 DNA Laboratory, Department of Pediatric Neurology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital , Praha, Czech Republic .
authors.forename: Marcela
authors.initials: M
authors.lastname: Krutova
mesh_terms: D000368:Aged; D019943:Amino Acid Substitution; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002939:Ciprofloxacin / Q000494:pharmacology; D002981:Clindamycin / Q000494:pharmacology; D016360:Clostridioides difficile / Q000145:classification / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification; D003015:Clostridium Infections / Q000188:drug therapy / Q000382:microbiology; D018153:Czech Republic; D027081:DNA Gyrase / Q000235:genetics* / Q000378:metabolism; D004269:DNA, Bacterial / Q000235:genetics* / Q000378:metabolism; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics*; D019075:Electrophoresis, Capillary; D005260:Female; D024841:Fluoroquinolones / Q000494:pharmacology; D015870:Gene Expression; D006801:Humans; D008297:Male; D008780:Methyltransferases / Q000235:genetics* / Q000378:metabolism; D008795:Metronidazole / Q000494:pharmacology; D008826:Microbial Sensitivity Tests; D018598:Minisatellite Repeats; D000077266:Moxifloxacin; D058885:Multilocus Sequence Typing; D012189:Retrospective Studies; D021521:Ribotyping; D062606:Tertiary Care Centers; D014640:Vancomycin / Q000494:pharmacology
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D024841:Fluoroquinolones; D008795:Metronidazole; D002981:Clindamycin; D002939:Ciprofloxacin; D014640:Vancomycin; D008780:Methyltransferases; C035181:rRNA (adenosine-O-2'-)methyltransferase; D027081:DNA Gyrase; D000077266:Moxifloxacin
keywords: Clostridium difficile; MLVA; PCR ribotype 001; Thr82Ile; antimicrobial drug resistance; capillary electrophoresis ribotyping