title: Predominance of Clostridium difficile 027 during a five-year period in Bolzano, Northern Italy.
abstract: Toxigenic Clostridium difficile is responsible for antibiotic-associated diarrhoea and other diseases. The increasing frequency and severity is attributed to highly-virulent ribotypes such as 027. The aim of the study was to collect epidemiological and molecular data for C. difficile isolates during 2009-2013 in the Central Hospital of Bolzano, Northern Italy. Stool samples from inpatients of the Bolzano Central Hospital were screened for toxins A and B, and C. difficile was cultured and tested for antibiotic susceptibility. PCRs were performed for genes of toxin A, toxin B, binary toxin and ribotyping. During the period 2009-13 from 320 patients (9% of patients tested) at least one stool sample proved positive for C. difficile toxins, and incidences for all hospital inpatients per 10,000 patient days (per 1,000 admissions) varied between 2.2 (1.5) and 4.3 (3.0). Out of 138 isolates (43% of total isolates were studied), 24 different ribotypes were identified. Isolates with ribotype 027 were predominant (38%), followed by 018 (13%) and 607 (10%). Whereas for ribotype 018 a significant decrease was seen during the five-year period, ribotype 027 increased significantly from 0% in 2009 to 64% in 2012, decreasing then to 10% in 2013. Isolates were sensitive to metronidazole and vancomycin, whereas isolates of the three major ribotypes were resistant to moxifloxacin. Our data indicates a significant change in C. difficile incidence rates and ribotype frequencies during the five-year period in the Central Hospital in Bolzano.
authors.affiliation: Laboratory of Microbiology and Virology, Central Hospital of Bolzano, Italy.
authors.forename: Richard
authors.initials: R
authors.lastname: Aschbacher
authors.affiliation: Austrian Agency for Health & Food Safety, Vienna, Austria.
authors.forename: Alexander
authors.initials: A
authors.lastname: Indra
authors.affiliation: Department of Internal Medicine, Central Hospital of Bolzano, Italy.
authors.forename: Christian J
authors.initials: CJ
authors.lastname: Wiedermann
authors.affiliation: Department of Geriatrics, Central Hospital of Bolzano, Italy.
authors.forename: Albert
authors.initials: A
authors.lastname: March
authors.affiliation: Department of Nephrology, Central Hospital of Bolzano, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Giacon
authors.affiliation: Department of Infectious Diseases, Central Hospital of Bolzano, Italy.
authors.forename: Peter
authors.initials: P
authors.lastname: Mian
authors.affiliation: Service of Hospital Hygiene, Central Hospital of Bolzano, Italy.
authors.forename: Mirella
authors.initials: M
authors.lastname: Bombonato
authors.affiliation: Department of Internal Medicine, Central Hospital of Bolzano, Italy.
authors.forename: Angelika
authors.initials: A
authors.lastname: Kaneppele
authors.affiliation: Department of Internal Medicine, Central Hospital of Bolzano, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Sansone
authors.affiliation: Department of Geriatrics, Central Hospital of Bolzano, Italy.
authors.forename: Johanna
authors.initials: J
authors.lastname: Burth
authors.affiliation: Department of Geriatrics, Central Hospital of Bolzano, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Felici
authors.affiliation: Department of Geriatrics, Central Hospital of Bolzano, Italy.
authors.forename: Franziska
authors.initials: F
authors.lastname: Ebner
authors.affiliation: Department of Nephrology, Central Hospital of Bolzano, Italy.
authors.forename: Werner
authors.initials: W
authors.lastname: Passler
authors.affiliation: Department of Nephrology, Central Hospital of Bolzano, Italy.
authors.forename: Renelda M
authors.initials: RM
authors.lastname: Lerchner
authors.affiliation: Department of Infectious Diseases, Central Hospital of Bolzano, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Vedovelli
authors.affiliation: Department of Infectious Diseases, Central Hospital of Bolzano, Italy.
authors.forename: Greta
authors.initials: G
authors.lastname: Spoladore
authors.affiliation: 1Laboratory of Microbiology and Virology, Central Hospital of Bolzano, Italy 2Austrian Agency for Health & Food Safety, Vienna, Austria 3Department of Internal Medicine, Central Hospital of Bolzano, Italy 4Department of Geriatrics, Central Hospital of Bolzano, Italy 5Department of Nephrology, Central Hospital of Bolzano, Italy 6Department of Infectious Diseases, Central Hospital of Bolzano, Italy 7Service of Hospital Hygiene, Central Hospital of Bolzano, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Binazzi
authors.affiliation: Department of Infectious Diseases, Central Hospital of Bolzano, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Pagani
authors.affiliation: Laboratory of Microbiology and Virology, Central Hospital of Bolzano, Italy.
authors.forename: Ludwig
authors.initials: L
authors.lastname: Moroder
authors.affiliation: Laboratory of Microbiology and Virology, Central Hospital of Bolzano, Italy.
authors.forename: Clara
authors.initials: C
authors.lastname: Larcher
authors.affiliation: Laboratory of Microbiology and Virology, Central Hospital of Bolzano, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Pagani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology* / Q000235:genetics; D003967:Diarrhea / Q000382:microbiology; D024881:Drug Resistance, Bacterial / Q000235:genetics; D005260:Female; D006801:Humans; D015994:Incidence; D007297:Inpatients / Q000706:statistics & numerical data*; D007558:Italy / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests / Q000379:methods; D008875:Middle Aged; D012189:Retrospective Studies; D021521:Ribotyping