Clostridium difficile in Europe: results of the 2005 European-wide survey

Abstract number: 1732_143

Barbut F., Mastrantonio P., Delmée M., Ackermann G., Bouza E., Balmelli C., Drudy D., Kuijper E., Ladas H., Nagy E., Pituch H., Wullt M., Yücesoy M., Rupnik M., Poxton for the European Study Group on Clostridium difficile I.

The recent emergence of the epidemic Clostridium difficile strain 027 in Europe could lead to important changes in the epidemiology of C. difficile-associated diseases (CDAD) and requires an ongoing clinical and molecular surveillance of CDAD.

A two-month prospective study on C. difficile was conducted in 38 hospitals from 14 different European countries in order to get an overview on the phenotypic and genotypic features of isolates in 2005. Strains were isolated from diarrheic patients with suspected CDAD. They were characterised by toxinotyping and production of toxins A and B. Binary toxin genes (cdtA and cdtB) were detected by PCR. Minimal inhibition concentrations (MIC) of metronidazole, vancomycin, erythromycin, clindamycin, moxifloxacin and tetracycline were determined using the Etest method. Epidemic 027 strain was identified by PCR-ribotyping. Of 406 strains, 349 were toxigenic of which 89 (25.5%) were toxin variant strains. Major toxinotypes included toxinotype 0 (n = 260), V (n = 27), VIII (n = 22) and III (n = 22). Resistance to erythromycin, clindamycin, moxifloxacin and tetracycline was found in 45.8%, 50.6%, 9.1% and 33.7%, respectively. All the strains were fully susceptible to metronidazole and vancomycin. Resistance to moxifloxacin and erythromycin was tightly associated and MICs of moxifloxacin were significantly higher in patients previously treated with fluoroquinolones. Prevalence of the 027 epidemic strain was 5.7%. It was found in Ireland (n = 1), Netherlands (n = 8) and Belgium (n = 11). This strain exhibits the same phenotypic and genotypic features as the NAP1 clone described in North America: it is positive for binary toxin genes, it has an18-bp deletion in tcdC gene and it is resistant to erythromycin and moxifloxacin. Mean incidence of CDAD was 2.45 cases per 10,000 patient-days but it varied widely from one hospital to another. Patients infected with 027 strain were likely to have a more severe disease (RR = 1.72, 95% CI: 1.07–2.75, p = 0.048), to have received less antimicrobials in the month preceding diarrhoea (RR = 0.76, 95% CI: 0.53–1.10, p = 0.05) and to have been more specifically treated by metronidazole or vancomycin (RR = 1.32, 1.17–1.49, p = 0.02). On-going epidemiologic surveillance of CDAD cases with periodic characterisation of the strains is needed to timely detect clustering of cases and to monitor the emergence of a specific hypervirulent clone.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Location: ICC, Munich, Germany
Presentation type:
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