Multidrug resistance in European Clostridium difficile clinical isolates

Patrizia Spigaglia, Fabrizio Barbanti, Paola Mastrantonio, G. Ackermann, C. Balmelli, F. Barbut, E. Bouza, J. Brazier, M. Delḿe, D. Drudy, E. Kuijper, H. Ladas, P. Mastrantonio, E. Nagy, H. Pituch, I. Poxton, M. Rupnik, M. Wullt, M. Ÿcesoy

Research output: Contribution to journalArticle

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Abstract

Objectives: Multidrug resistance and antibiotic resistance mechanisms were investigated in 316 Clostridium difficile clinical isolates collected during the first European surveillance on C. difficile in 2005. Methods: MICs of eight different antibiotics were determined using Etest. Reserpine- and carbonyl cyanide m-chlorophenylhydrazone-sensitive efflux was tested using the agar dilution method. Molecular analysis of the resistance mechanisms was performed using PCR assays, PCR mapping and sequencing. Results: One hundred and forty-eight C. difficile strains were resistant to at least one antibiotic and 82 (55%) were multidrug resistant. In particular, 48% of these isolates were resistant to erythromycin, clindamycin, moxifloxacin and rifampicin. New genetic elements or determinants conferring resistance to erythromycin/clindamycin or tetracycline were identified. Even if most multiresistant strains carried an erm(B) gene, quite a few were erm(B) negative. In-depth analysis of the underlying mechanism in these isolates was carried out, including analysis of 23S rDNA and the ribosomal proteins L4 and L22. Interestingly, resistance to rifampicin was observed in multidrug-resistant strains in association with resistance to fluoroquinolones. Mutations in the rpo(B) and gyrA genes were identified as the cause of resistance to these antibiotics, respectively. Conclusions: Characterization of multidrug-resistant C. difficile clinical isolates shows that antibiotic resistance is changing, involving new determinants and mechanisms and providing this pathogen with potential advantages over the co-resident gut flora. The present paper provides, for the first time, a comprehensive picture of the different characteristics of multidrug-resistant C. difficile strains in Europe in 2005 and represents an important source of data for future comparative European studies.

Original languageEnglish
Article numberdkr292
Pages (from-to)2227-2234
Number of pages8
JournalJournal of Antimicrobial Chemotherapy
Volume66
Issue number10
DOIs
Publication statusPublished - Oct 1 2011

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Clostridium difficile
Multiple Drug Resistance
Microbial Drug Resistance
Clindamycin
Erythromycin
Rifampin
Disk Diffusion Antimicrobial Tests
Anti-Bacterial Agents
Polymerase Chain Reaction
Information Storage and Retrieval
Reserpine
Fluoroquinolones
Ribosomal DNA
Tetracycline
Genes
Agar
Mutation

Keywords

  • Antibiotics
  • Resistance mechanisms
  • Surveillance

ASJC Scopus subject areas

  • Pharmacology
  • Microbiology (medical)
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Spigaglia, P., Barbanti, F., Mastrantonio, P., Ackermann, G., Balmelli, C., Barbut, F., ... Ÿcesoy, M. (2011). Multidrug resistance in European Clostridium difficile clinical isolates. Journal of Antimicrobial Chemotherapy, 66(10), 2227-2234. [dkr292]. https://doi.org/10.1093/jac/dkr292

Multidrug resistance in European Clostridium difficile clinical isolates. / Spigaglia, Patrizia; Barbanti, Fabrizio; Mastrantonio, Paola; Ackermann, G.; Balmelli, C.; Barbut, F.; Bouza, E.; Brazier, J.; Delḿe, M.; Drudy, D.; Kuijper, E.; Ladas, H.; Mastrantonio, P.; Nagy, E.; Pituch, H.; Poxton, I.; Rupnik, M.; Wullt, M.; Ÿcesoy, M.

In: Journal of Antimicrobial Chemotherapy, Vol. 66, No. 10, dkr292, 01.10.2011, p. 2227-2234.

Research output: Contribution to journalArticle

Spigaglia, P, Barbanti, F, Mastrantonio, P, Ackermann, G, Balmelli, C, Barbut, F, Bouza, E, Brazier, J, Delḿe, M, Drudy, D, Kuijper, E, Ladas, H, Mastrantonio, P, Nagy, E, Pituch, H, Poxton, I, Rupnik, M, Wullt, M & Ÿcesoy, M 2011, 'Multidrug resistance in European Clostridium difficile clinical isolates', Journal of Antimicrobial Chemotherapy, vol. 66, no. 10, dkr292, pp. 2227-2234. https://doi.org/10.1093/jac/dkr292
Spigaglia P, Barbanti F, Mastrantonio P, Ackermann G, Balmelli C, Barbut F et al. Multidrug resistance in European Clostridium difficile clinical isolates. Journal of Antimicrobial Chemotherapy. 2011 Oct 1;66(10):2227-2234. dkr292. https://doi.org/10.1093/jac/dkr292
Spigaglia, Patrizia ; Barbanti, Fabrizio ; Mastrantonio, Paola ; Ackermann, G. ; Balmelli, C. ; Barbut, F. ; Bouza, E. ; Brazier, J. ; Delḿe, M. ; Drudy, D. ; Kuijper, E. ; Ladas, H. ; Mastrantonio, P. ; Nagy, E. ; Pituch, H. ; Poxton, I. ; Rupnik, M. ; Wullt, M. ; Ÿcesoy, M. / Multidrug resistance in European Clostridium difficile clinical isolates. In: Journal of Antimicrobial Chemotherapy. 2011 ; Vol. 66, No. 10. pp. 2227-2234.
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AU - Bouza, E.

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