Surveillance for Antibiotic Resistance in Clostridium difficile Strains Isolated from Patients in a Tertiary Care Center
Affiliation(s)
1 Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. 2 Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
1 Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. 2 Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
ABSTRACT
Clostridium difficile is the major etiological agent of nosocomial diarrhea primarily precipitated by antimicrobial therapy. We prospectively investigated the antibiogram profile of C. difficile strains isolated from patients reporting to a tertiary care hospital in North India. Fecal samples obtained from 1110 suspected cases of C. difficile infection were cultured for isolation of C. difficile. Colonies suspected as those of C. difficile were identified by phenotypic and molecular methods. Antimicrobial susceptibility of C. difficile isolates for different classes of antibiotics was determined using the Epsilon test for vancomycin, metronidazole, clindamycin and ciprofloxacin. The fecal samples cultured for C. difficile belonged to 709 (63.9%) males and 401 (36.1%) females. The mean age of the patients was 38.7 years. C. difficile was cultured from 174 (15.7%) of the total samples. Antibiotic resistance was largely observed towards clindamycin (57.5%) and ciprofloxacin (38.5%) but was significantly low towards metronidazole (1.72%) and nil (0%) towards vancomycin. C. difficile isolates had a high degree of resistance towards clindamycin and ciprofloxacin with low level of resistance to metronidazole and none towards vancomycin. Antibiogram surveillance of C. difficile will help for clinical practice and add to the epidemiological data of the organisms.
Clostridium difficile is the major etiological agent of nosocomial diarrhea primarily precipitated by antimicrobial therapy. We prospectively investigated the antibiogram profile of C. difficile strains isolated from patients reporting to a tertiary care hospital in North India. Fecal samples obtained from 1110 suspected cases of C. difficile infection were cultured for isolation of C. difficile. Colonies suspected as those of C. difficile were identified by phenotypic and molecular methods. Antimicrobial susceptibility of C. difficile isolates for different classes of antibiotics was determined using the Epsilon test for vancomycin, metronidazole, clindamycin and ciprofloxacin. The fecal samples cultured for C. difficile belonged to 709 (63.9%) males and 401 (36.1%) females. The mean age of the patients was 38.7 years. C. difficile was cultured from 174 (15.7%) of the total samples. Antibiotic resistance was largely observed towards clindamycin (57.5%) and ciprofloxacin (38.5%) but was significantly low towards metronidazole (1.72%) and nil (0%) towards vancomycin. C. difficile isolates had a high degree of resistance towards clindamycin and ciprofloxacin with low level of resistance to metronidazole and none towards vancomycin. Antibiogram surveillance of C. difficile will help for clinical practice and add to the epidemiological data of the organisms.
Cite this paper
Singh, M. , Vaishnavi, C. , Mahmood, S. and Kochhar, R. (2015) Surveillance for Antibiotic Resistance in Clostridium difficile Strains Isolated from Patients in a Tertiary Care Center. Advances in Microbiology, 5, 336-345. doi: 10.4236/aim.2015.55034.
Singh, M. , Vaishnavi, C. , Mahmood, S. and Kochhar, R. (2015) Surveillance for Antibiotic Resistance in Clostridium difficile Strains Isolated from Patients in a Tertiary Care Center. Advances in Microbiology, 5, 336-345. doi: 10.4236/aim.2015.55034.
References
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http://dx.doi.org/10.1016/S1286-4579(00)01343-5 [2] Burke, K.E. and Lamont, J.T. (2014) Clostridium difficile Infection: A Worldwide Disease. Gut and Liver, 8, 1-6.
http://dx.doi.org/10.5009/gnl.2014.8.1.1 [3] Jalali, M., Khorvash, F., Warriner, K. and Weese, J.S. (2012) Clostridium difficile Infection in an Iranian Hospital. BMC Research Notes, 5, 159.
http://dx.doi.org/10.1186/1756-0500-5-159 [4] Zar, F.A., Bakkanagari, S.R., Moorthi, K.M. and Davis, M.B. (2007) A Comparison of Vancomycin and Metronidazole for the Treatment of Clostridium difficile-Associated Diarrhea, Stratified by Disease Severity. Clinical Infectious Diseases, 45, 302-307.
http://dx.doi.org/10.1086/519265 [5] Barbut, F., Delmee, M., Brazier, J.S., Petit, J.C., Poxton, I.R., Rupnik, M., Lalande, V., Schneider, C., Mastrantonio, P., Alonso, R., Kuipjer, E., Tvede, M. and The ESCMID Study Group on Clostridium difficile (ESGCD) (2003) A European Survey of Diagnostic Methods and Testing Protocols for Clostridium difficile. Clinical Microbiology and Infection, 9, 989-996.
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http://dx.doi.org/10.1053/jhin.1999.0253 [10] Wren, M. (2010) Clostridium difficile Isolation and Culture Techniques Methods. Journal of Molecular Biology, 646, 39-52.
http://dx.doi.org/10.1007/978-1-60327-365-7_3 [11] Drudy, D., Kyne, L., O’Mahony, R. and Fanning, S. (2007) GyrA Mutations in Fluoroquinolone-Resistant Clostridium difficile PCR-027. Emerging Infectious Diseases, 13, 504-505.
http://dx.doi.org/10.3201/eid1303.060771 [12] Muto, C.A., Pokrywka, M., Shutt, K., Mendelsohn, A.B., Nouri, K., Posey, K., Roberts, T., Croyle, K., Krystofiak, S., Patel-Brown, S., Pasculle, A.W., Paterson, D.L., Saul, M. and Harrison, L.H. (2005) A Large Outbreak of Clostridium difficile-Associated Disease with an Unexpected Proportion of Deaths and Colectomies at a Teaching Hospital Following Increased Fluoroquinolone Use. Infection Control and Hospital Epidemiology, 26, 273-280.
http://dx.doi.org/10.1086/502539 [13] Drudy, D., Quinn, T., O’Mahony, R., Kyne, L., O’Gaora, P. and Fanning, S. (2006) High-Level Resistance to Moxifloxacin and Gatifloxacin Associated with a Novel Mutation in GyrB in Toxin-A-Negative, Toxin-B-Positive Clostridium difficile. Journal of Antimicrobial Chemotherapy, 58, 1264-1267.
http://dx.doi.org/10.1093/jac/dkl398 [14] Poilane, I., Cruaud, P., Torlotin, J.C. and Collignon, A. (2000) Comparison of the E-Test to the Reference Agar Dilution Method for Antibiotic Susceptibility Testing of Clostridium difficile. Clinical Microbiology and Infection, 6, 155-156.
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