An Outbreak of Clostridium (Clostridioides) difficile Infections within an Acute and Long-Term Care Wards Due to Moxifloxacin-Resistant PCR Ribotype 176 Genotyped as PCR Ribotype 027 by a Commercial Assay

Elena Novakova; Nina Kotlebova; Anezka Gryndlerova; Martin Novak; Michala Vladarova; Mark Wilcox; Ed Kuijper; Marcela Krutova

doi:10.3390/jcm9113738

An Outbreak of Clostridium (Clostridioides) difficile Infections within an Acute and Long-Term Care Wards Due to Moxifloxacin-Resistant PCR Ribotype 176 Genotyped as PCR Ribotype 027 by a Commercial Assay

J Clin Med. 2020 Nov 20;9(11):3738. doi: 10.3390/jcm9113738.

Authors

Elena Novakova¹, Nina Kotlebova¹, Anezka Gryndlerova², Martin Novak¹, Michala Vladarova³, Mark Wilcox⁴, Ed Kuijper⁵, Marcela Krutova²

Affiliations

¹ Department of Microbiology and Immunology, Comenius University Jessenius Faculty of Medicine, 036 01 Martin, Slovakia.
² Department of Medical Microbiology, Charles University, 2nd Faculty of Medicine and Motol University Hospital, 150 06 Prague, Czech Republic.
³ Department of Clinical Microbiology, Clinical Biochemistry Inc., 012 07 Zilina, Slovakia.
⁴ Healthcare Associated Infection Research Group, Leeds Teaching Hospitals NHS Trust & University of Leeds, Leeds LS2 9JT, UK.
⁵ Department of Medical Microbiology, Leiden University Medical Centre, 2300 Leiden, The Netherlands.

Abstract

We aimed to characterize Clostridioides difficile isolates cultured during a six-month single-center study from stool samples of patients with C. difficile infection (CDI) genotyped by the Xpert^®C. difficile/Epi assay by polymerase chain reaction (PCR) ribotyping, toxin genes' detection and multi-locus variable number tandem repeats analysis (MLVA). The susceptibility to metronidazole, vancomycin and moxifloxacin was determined by agar dilution. In addition, the presence of Thr82Ile in the GyrA and a single nucleotide deletion at position (Δ117) in the tcdC gene were investigated. Between January 1 and June 30, 2016, of 114 CDIs, 75 cases were genotyped as presumptive PCR ribotype (RT) 027 infections using a commercial assay. C. difficile isolates cultured from presumptive RT027 stool samples belonged to RT176. These isolates carried genes for toxin A (tcdA), B (tcdB), binary (cdtA/B) and had Δ117 in the tcdC gene. Using MLVA, the 71/75 isolates clustered into two clonal complexes (CCs). Of these, 39 isolates (54.9%) were from patients hospitalized in acute care and 32 isolates (45.1%) were isolated from patients hospitalized in the long-term care department. All isolates were susceptible to metronidazole and vancomycin, and 105 isolates were resistant to moxifloxacin (92%) carrying Thr83Ile in the GyrA. An outbreak of RT176 CDIs, suspected as RT027, was recognized in a Slovakian hospital. In order to monitor the emergence and spread of RT027-variants, the identification of a presumptive RT027 CDI should be confirmed at a strain level by PCR ribotyping.

Keywords: MLVA; Slovakia; Thr82Ile; binary toxin; ribotyping; tcdC; Δ117.