Increasing incidence of Clostridium difficile ribotype 001 associated with severe course of the infection and previous fluoroquinolone use in the Czech Republic, 2015.

M Krutova, J Matejkova, P Drevinek, E J Kuijper, O Nyc, study group
Author Information
  1. M Krutova: Department of Medical Microbiology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Uvalu 84, 150 06, Prague 5, Czech Republic. marcela.krutova@lfmotol.cuni.cz.
  2. J Matejkova: Department of Medical Microbiology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Uvalu 84, 150 06, Prague 5, Czech Republic.
  3. P Drevinek: Department of Medical Microbiology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Uvalu 84, 150 06, Prague 5, Czech Republic.
  4. E J Kuijper: Leiden University Medical Centre, Leiden, the Netherlands.
  5. O Nyc: Department of Medical Microbiology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Uvalu 84, 150 06, Prague 5, Czech Republic.

Abstract

The aim of the study was to provide an update on the epidemiology of C. difficile infection (CDI) in a representative number of hospitals within the Czech Republic in 2015. In 2015, twenty-eight Czech hospitals were invited to participate in a CDI study. Laboratories sent the first 20 consecutive C. difficile isolates for characterization by capillary-electrophoresis (CE) ribotyping and the presence of toxin genes and collected patient data on previous hospitalization, antibiotic treatment, the number of CDI episodes and the course of CDI. The mean incidence of CDI was 5.2 [95% CI 4.2-6.2] cases per 10,000 patient-bed days in 27 hospitals in 2015. Of 490 C. difficile isolates, the prevalent PCR ribotypes (RTs) were 001 (n = 164, 33.5%) and 176 (n = 125, 25.5%) followed by 014 (n = 37, 7.6%), 012 (n = 17, 3.5%), 020 (n = 16, 3.3%), 017 (n = 14, 2.9%) and 002 (n = 11, 2.2%). A severe course of CDI was reported in 104 cases (21.2%) with significant association with RT001 infection (p = 0.03). CDI recurrence was 10.8% (n = 53). The previous use of fluoroquinolones was associated with RTs 001 and 176 CDIs (p = 0.046 and p = 0.041). We observed a persistence of RTs 001 and 176 CDIs in the Czech Republic that was associated with the previous use of fluoroquinolones. This highlights the need for a reduction in fluoroquinolone use in Czech hospital settings.

Keywords

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MeSH Term

Aged
Anti-Bacterial Agents
Clostridioides difficile
Cross Infection
Czech Republic
Drug Resistance, Bacterial
Enterocolitis, Pseudomembranous
Fluoroquinolones
Hospitals
Humans
Ribotyping

Chemicals

Anti-Bacterial Agents
Fluoroquinolones

Word Cloud

Created with Highcharts 10.0.0CDIdifficileCzechinfection2015previous001useChospitalsRepubliccourse2RTs5%176p = 0associatedClostridiumstudynumberisolatesribotypinggenesincidencecases1032%severefluoroquinolonesCDIsfluoroquinoloneaimprovideupdateepidemiologyrepresentativewithintwenty-eightinvitedparticipateLaboratoriessentfirst20consecutivecharacterizationcapillary-electrophoresisCEpresencetoxincollectedpatientdatahospitalizationantibiotictreatmentepisodesmean5[95%CI42-62]per000patient-beddays27490prevalentPCRribotypesn = 16433n = 12525followed014n = 3776%012n = 17020n = 163%017n = 149%002n = 11reported10421significantassociationRT00103recurrence8%n = 53046041observedpersistencehighlightsneedreductionhospitalsettingsIncreasingribotypesurveillanceCapillaryelectrophoresisFluoroquinolonesToxin

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