Clostridium difficile Strains Associated with Nosocomial Infections - Laboratory Diagnosis, Prevalence, Susceptibility and Molecular Characterization of the Isolates
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Abstract
Although there was not much attention about the role of this bacterium in the past, Clostridium difficile is one of the most important agents associated with nosocomial infections today. The main reason for this is its resistance against many antibiotics and environmental conditions as a result to its ability to form spores and to produce toxins.
There are no data for the prevalence of the infections with Clostridium difficile in the Republic of Macedonia. Also, the resistance and the molecular characterization of the isolated strains haven't been explored.
Using the "Pubmed Central" database, we have analyzed 65 peer reviewed articles concerning this topic and we have collected interesting information about Clostridium difficile strains that had been isolated from hospitalized patients from all over the world, suffering mostly from antibiotic associated diarrhea.
In terms of diagnosis, the tree-step algorithm has been recommended (direct screening of glutamate dehydrogenase- GDH, plus fecal detection of toxins A and B and toxigenic culture) as an effective way for the detection of this infection. That way, we would be able to detect many cases that would have been missed if using the other algorithms. As a result of this, direct transmission of C.difficile in the hospitals can be prevented and costs of prolonged hospitalization can be reduced.
Oral metronidazole or vancomycin is the standard therapy for C. difficile infection.
Patients with severe and refractory C. difficile infections have been treated successfully with intravenous tigecycline. Tigecycline had the lowest MIC90 values for C. difficile and was followed by daptomycin, metronidazole, and vancomycin (1 μg/ml). Clindamycin showed the highest MICs of all antimicrobial agents tested. The use of clindamycin is associated with a high risk of inducing C. difficile infection.
In most of the studies, all of the strains have been susceptible to metronidazole, vancomycin, daptomycin and tigecycline whereas only strains belonging to ribotype 018 have been resistant to moxifloxacin. Ribotype 018 is the most frequent ribotype and all the isolates of this ribotype proved resistant to fluoroqinolones, suggesting that the increased use of this antibiotics has played a determinant role in selection and spread of this strains.
Outbreaks of C. difficile infections, particularly toxigenic strains such as ribotype NAP1/027, were often reported in the Europe, United States and Canada.Downloads
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