The largely unnoticed spread of Clostridioides difficile PCR ribotype 027 in Germany after 2010

Since 2003, the emergence and distribution of a hypervirulent strain of Clostridium difficile PCR ribotype 027 has been described in North America, Japan and several European countries [1-6]. In December 2007, C. difficile PCR ribotype 027 was found in two cases of C. difficile-associated disease treated in a hospital in Oslo, Norway.

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Update of Clostridium difficile infection due to PCR ribotype 027 in Europe, 2008

Eurosurveillance ◽

10.2807/ese.13.31.18942-en ◽

2008 ◽

Vol 13 (31) ◽

Cited By ~ 2

Author(s):

E J Kuijper ◽

F Barbut ◽

J S Brazier ◽

N Kleinkauf ◽

T Eckmanns ◽

...

Keyword(s):

Clostridium Difficile ◽

European Countries ◽

Epidemiological Surveillance ◽

Resistance Pattern ◽

Positive Type ◽

Ribotype 027 ◽

High Relapse Rate ◽

The United Kingdom ◽

Pcr Ribotype 027 ◽

Highly Virulent

Outbreaks of Clostridium difficile infections (CDI) with increased severity, high relapse rate and significant mortality have been related to the emergence of a new, hypervirulent C. difficile strain in North America and Europe. This emerging strain is referred to as PCR ribotype 027 (Type 027). Since 2005, individual countries have developed surveillance studies about the spread of type 027. C. difficile Type 027 has been reported in 16 European countries. It has been responsible for outbreaks in Belgium, Germany, Finland, France, Ireland, Luxembourg, The Netherlands, Switzerland and the United Kingdom (England, Wales, Northern Ireland and Scotland). It has also been detected in Austria, Denmark, Sweden, Norway, Hungary, Poland and Spain. Three countries experienced imported patients with CDI due to Type 027 who acquired the infection abroad. The antimicrobial resistance pattern is changing, and outbreaks due to clindamycin-resistant ermB positive Type 027 strains have occurred in three European countries. Ongoing epidemiological surveillance of cases of CDI, with periodic characterisation of the strains involved, is required to detect clustering of cases in time and space and to monitor the emergence of new, highly virulent clones.

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Clostridium difficile erm(B)-containing elements and the burden on the in vitro fitness

Journal of Medical Microbiology ◽

10.1099/jmm.0.057117-0 ◽

2013 ◽

Vol 62 (9) ◽

pp. 1461-1467 ◽

Cited By ~ 19

Author(s):

François Wasels ◽

Patrizia Spigaglia ◽

Fabrizio Barbanti ◽

Paola Mastrantonio

Keyword(s):

Clostridium Difficile ◽

Clinical Isolates ◽

Surveillance Study ◽

Conjugative Transposon ◽

Genetic Organization ◽

Ribotype 027 ◽

Pcr Ribotype 027

In Clostridium difficile, resistance to the macrolide-lincosamide-streptogramin B group of antibiotics generally relies on erm(B) genes. In this study, we investigated elements with a genetic organization different from Tn5398, the mobilizable non-conjugative element identified in C. difficile strain 630. Our results suggested that the elements most frequently found in strains isolated during the European surveillance study in 2005 were related to Tn6194, the conjugative transposon recently detected in different C. difficile types, including PCR-ribotype 027. We characterized a Tn6194-like and a novel element rarely found in clinical isolates. A burden on the in vitro fitness of C. difficile was observed after the acquisition of these elements as well as of Tn5398.

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Antimicrobial susceptibility of Clostridioides difficile isolated from diarrhoeal stool specimens of Canadian patients: summary of results from the Canadian Clostridioides difficile (CAN-DIFF) surveillance study from 2013 to 2017

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkaa118 ◽

2020 ◽

Vol 75 (7) ◽

pp. 1824-1832

Author(s):

James A Karlowsky ◽

Heather J Adam ◽

Melanie R Baxter ◽

Christopher W Dutka ◽

Kim A Nichol ◽

...

Keyword(s):

Antimicrobial Susceptibility ◽

Susceptibility Testing ◽

Surveillance Study ◽

Dilution Method ◽

Agar Dilution Method ◽

In Vitro Susceptibility ◽

Ribotype 027 ◽

Clostridioides Difficile ◽

Vancomycin Mics ◽

Stool Specimens

Abstract Objectives To summarize data generated by the Canadian Clostridioides difficile (CAN-DIFF) surveillance study from 2013 to 2017. Methods Isolates of C. difficile (n = 2158) were cultured from toxin-positive diarrhoeal stool specimens submitted by eight hospital laboratories to a coordinating laboratory. Antimicrobial susceptibility testing was performed according to the CLSI agar dilution method (M11, 2018). Isolate ribotypes were determined using an international, standardized, high-resolution capillary gel-based electrophoresis protocol. Results Of the 2158 isolates of C. difficile, 2133 (98.8%) had vancomycin MICs ≤2 mg/L [i.e. were vancomycin susceptible (EUCAST breakpoint tables, v 9.0, 2019) or WT (CLSI M100, 29th edition, 2019)]. Fidaxomicin MICs were lower than those of all other agents tested (MIC90, 0.5 mg/L); however, one isolate with a fidaxomicin MIC of >8 mg/L was identified. Metronidazole MICs ranged from 0.12 to 4 mg/L; all isolates were metronidazole susceptible by the CLSI breakpoint (≤8 mg/L) compared with 96.8% susceptible by the EUCAST breakpoint (≤2 mg/L). In total, 182 different ribotypes were identified from 2013 to 2017. The most common ribotypes identified were 027 (19.3% of isolates) and 106 (8.2%). Ribotype 027 isolates were frequently moxifloxacin resistant (87.3% of isolates) and MDR (48.6%), associated with vancomycin (10/25, 40.0%) and metronidazole (58/69, 84.1%) resistance and from patients aged ≥80 years. The prevalence of ribotype 027 decreased significantly (P < 0.0001) from 2013 (27.5%) to 2017 (9.0%) and was replaced by increases in ribotype 106 (P = 0.0003) and multiple less common ribotypes. Conclusions Periodic surveillance is required to monitor clinical isolates of C. difficile for changes to in vitro susceptibility testing profiles and ribotype evolution.

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