In vitro antibiotic susceptibility profile of Clostridium difficile excluding PCR ribotype 027 outbreak strain in Hungary.

Our study showed the antibiotic susceptibility profile of toxigenic Clostridium difficile isolated from nosocomial and community-acquired CDI between 2008 and 2010. MICs of 200 C. difficile strains were determined using E®test method in the case of erythromycin, clindamycin, moxifloxacin, rifampicin, and metronidazole. All strains were susceptible to metronidazole in the study period. Resistance rates to erythromycin, clindamycin and moxifloxacin were 31%, 29.5%, and 21.5%, respectively. In the case of rifampicin, the MIC range was quite wide, 11.5% of the tested strains proved to be highly resistant (MIC≥32 µg/ml) to rifampicin. When we compared these results with our earlier findings from 2006 to 2007, only minor changes in susceptibility over the time-periods could be observed in the case of erythromycin, clindamycin, moxifloxacin, and rifampicin, but metronidazole susceptibility did not show changes.

Assessment of changes in the epidemiology of Clostridium difficile isolated from diarrheal patients in Hungary.

150 Clostridium difficile strains isolated from diarrheal feces were collected from three parts of Hungary and the presence of genes responsible for toxin A and B, and binary toxin production were examined. MIC distribution against clindamycin, erythromycin, metronidazole, moxifloxacin and rifampin of 80 toxigenic strains selected from the above-mentioned strains and 20 large clostridial toxins (LCTs)-positive strains chosen from our earlier strain collection were determined. 80% of the examined 150 strains were positive for both tcdA and tcdB, and no toxin A-negative, toxin B-positive isolates were found during the study period. 5.3% of toxigenic strains proved to be positive for binary toxin too. Among binary toxin-positive strains, one strain showed the same pattern characteristic of PCR ribotype 027. Comparison of recent findings and our earlier results, the prevalence of toxin-producing and binary toxin-positive strains among C. difficile isolated from diarrheal specimens increased. No metronidazole resistant isolate was detected among strains isolated in 2002-2003 and 2006-2007. The rates of resistance to erythromycin, clindamycin, moxifloxacin and rifampin among strains isolated between 2006 and 2007 were 25%, 27.5%, 25% and 6.3%, respectively. Erythromycin resistance was frequently associated with clindamycin and moxifloxacin resistance, however this resistant phenotype was not found among strains isolated in 2002-2003.