Implementation of a Clostridioides difficile sentinel surveillance system in Germany: First insights for 2019-2021

Ahmed Mohamed Mostafa Abdrabou; Markus Bischoff; Alexander Mellmann; Lutz von Müller; Lena Margardt; Barbara C Gärtner; Fabian K Berger; German C. difficile surveillance group

doi:10.1016/j.anaerobe.2022.102548

Implementation of a Clostridioides difficile sentinel surveillance system in Germany: First insights for 2019-2021

Anaerobe. 2022 Oct:77:102548. doi: 10.1016/j.anaerobe.2022.102548. Epub 2022 Mar 18.

Authors

Ahmed Mohamed Mostafa Abdrabou¹, Markus Bischoff², Alexander Mellmann³, Lutz von Müller⁴, Lena Margardt², Barbara C Gärtner², Fabian K Berger²; German C. difficile surveillance group

Collaborators

German C. difficile surveillance group:
Gerhard Haase⁵, Helga Häfner⁵, Reinhard Hoffmann⁶, Valeska Simon⁶, Hannes Stappmanns⁷, Gunnar T R Hischebeth⁸, Christian Büchler⁸, Susann Rößler⁹, Kristina Hochauf-Stange⁹, Klaus Pfeffer¹⁰, Colin MacKenzie¹⁰, Caroline Kunz¹¹, Rayya Alsalameh¹¹, Jan Dziobaka¹², Valérie Saout le Chapot¹², Erwin Sanabria¹³, Michael Hogardt¹³, Johanna Komp¹⁴, Can Imirzalioglu¹⁵, Judith Schmiedel¹⁵, Michael Pararas¹⁶, Frank Sommer¹⁶, Uwe Groß¹⁷, Wolfgang Bohne¹⁷, Alexander S Kekulé¹⁸, Urantschimeg Dagwadordsch¹⁸, Bettina Löffler¹⁹, Jürgen Rödel¹⁹, Sarah Victoria Walker²⁰, David Tobys²⁰, Simone Weikert-Asbeck²¹, Susanne Hauswaldt²¹, Achim J Kaasch²², Andreas E Zautner²², Nadja Joß²³, Ekkehard Siegel²³, Katharina Kehr²⁴, Frieder Schaumburg²⁵, Sarah Schoeler²⁵, Axel Hamprecht²⁶, Josef Hellkamp²⁶, Jürgen Benjamin Hagemann²⁷, Jan Kubis²⁷, Silvio Hering²⁸, Philipp Warnke²⁸

Affiliations

¹ Institute of Medical Microbiology and Hygiene, University of Saarland, Kirrberger Straße, Building 43, 66421, Homburg/Saar, Germany; Medical Microbiology and Immunology Department, Faculty of Medicine, Mansoura University, El Gomhouria Street, 35516, Mansoura, Egypt; German National Reference Center for Clostridioides (Clostridium) difficile, Homburg/Saar, Münster-Coesfeld, Germany. Electronic address: ahmed.mostafa@uks.eu.
² Institute of Medical Microbiology and Hygiene, University of Saarland, Kirrberger Straße, Building 43, 66421, Homburg/Saar, Germany; German National Reference Center for Clostridioides (Clostridium) difficile, Homburg/Saar, Münster-Coesfeld, Germany.
³ German National Reference Center for Clostridioides (Clostridium) difficile, Homburg/Saar, Münster-Coesfeld, Germany; Institute of Hygiene, University of Münster, Robert Koch Straße 41, 48149, Münster, Germany.
⁴ German National Reference Center for Clostridioides (Clostridium) difficile, Homburg/Saar, Münster-Coesfeld, Germany; Institute of Laboratory Medicine, Microbiology and Hygiene, Südring 41, Christophorus Kliniken, 48653, Coesfeld, Germany.
⁵ Labordiagnostisches Zentrum (LDZ), University Hospital RWTH Aachen, Aachen, Germany.
⁶ Universitätsklinikum Augsburg".
⁷ IML-Bochum GmbH, Germany.
⁸ Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany.
⁹ Institute of Medical Microbiology and Virology, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307, Dresden, Germany.
¹⁰ Düsseldorf University Hospital, Germany.
¹¹ Institute of Microbiology, University Hospital, Erlangen, Germany.
¹² Essen University Hospital, Germany.
¹³ Institute for Medical Microbiology and Infection Control, University Hospital, Goethe University, Frankfurt am Main, Germany; University Center of Competence for Infection Control of the State of Hesse, Frankfurt Main, Germany.
¹⁴ Medical Center - University of Freiburg, Institute for Microbiology and Hygiene, Germany.
¹⁵ Institute of Medical Microbiology, Justus Liebig University Giessen, and German Center for Infection Research (DZIF), Partner Site Giessen-Marburg-Langen, Giessen, Germany.
¹⁶ Institute of Medical Microbiology and Hospital Hygiene, Philipps-University Marburg, Marburg, Germany.
¹⁷ University Medical Center, Göttingen, Germany.
¹⁸ Institut für Medizinische Mikrobiologie, Universitätsklinikum Halle (Saale), Magdeburger Straße 6, 06112, Halle, Germany.
¹⁹ University Hospital, Jena, Germany.
²⁰ University Hospital, Cologne, Germany.
²¹ Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein, Campus Lübeck, Germany.
²² Institute of Medical Microbiology and Hospital Hygiene, University Hospital, Faculty of Medicine, Otto-von-Guericke-University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
²³ University Medical Center Mainz - Department of Medical Microbiology and Hygiene, Germany.
²⁴ Institute of Medical Microbiology and Hygiene, University Medical Center, Mannheim, Germany.
²⁵ Institute of Medical Microbiology, University Hospital Münster, Münster, Germany.
²⁶ Carl von Ossietzky Universität, Oldenburg, Germany.
²⁷ Institute of Medical Microbiology and Hygiene, Ulm University Hospital, Albert-Einstein-Allee 23, D-89081, Ulm, Germany.
²⁸ Rostock University Medical Center, Institute of Medical Microbiology, Virology and Hygiene, Germany.

PMID: 35307546
DOI: 10.1016/j.anaerobe.2022.102548

Abstract

Objectives: Clostridioides difficile is a major cause of nosocomial diarrhea. Several "hypervirulent" lineages such as ribotype 027 (RT027) and RT078 are of high epidemiological importance, leading to outbreaks and more severe courses of disease. An active surveillance system targeting molecular epidemiology and corresponding antimicrobial resistance has not been established in Germany.

Methods: Since October 2019, University Hospitals throughout Germany collected by two dates every year (1st April and October, respectively) their first ten unselected samples being tested positive for C. difficile.

Results: Out of 1026 samples received from 29 sites, 876 toxigenic C. difficile strains could be cultivated. PCR ribotyping of these strains revealed a large strain diversity with RT014 (17.5%) dominating, followed by isolates of the major nosocomial lineage RT001 (7.1%) and the "hypervirulent" lineage RT078 (5.9%). Notably, prevalence of RT027 was low with ∼3.5% at all time points analyzed, while the abundance of RT001 isolates significantly declined from 12.3% to 3.7% during the sampling period (P < 0.001). Antimicrobial resistance against clarithromycin, moxifloxacin, and rifampicin was detected in 18%, 15%, and 4% of the tested isolates, respectively. Highest resistance rates were found among RT027 isolates (83%, 87% and 63% for clarithromycin, moxifloxacin, and rifampicin, respectively). Vancomycin resistance was not detected, and metronidazole resistance was observed only for a single RT027 isolate.

Conclusions: This Germany-wide continuing surveillance effort with a standardized mode of isolate acquisition indicates that isolates of RT027 were only sporadically detected under these strain acquisition conditions, and RT001 seems to become less important in the hospital setting, being replaced by other RTs.

Keywords: Clostridium difficile; Epidemiology; Europe; Molecular characterization; PCR ribotyping; Susceptibility testing.

MeSH terms

Anti-Bacterial Agents / pharmacology
Anti-Bacterial Agents / therapeutic use
Clarithromycin
Clostridioides
Clostridioides difficile* / genetics
Clostridium Infections* / drug therapy
Clostridium Infections* / epidemiology
Cross Infection* / drug therapy
Cross Infection* / epidemiology
Drug Resistance, Bacterial
Humans
Microbial Sensitivity Tests
Moxifloxacin
Multilocus Sequence Typing
Ribotyping
Rifampin
Sentinel Surveillance

Substances

Moxifloxacin
Clarithromycin
Rifampin
Anti-Bacterial Agents