The epidemiology of clostridium difficile in scotland.
J Infect. 2011 Feb 4;
Authors: Wiuff C, Brown DJ, Mather H, Banks AL, Eastaway A, Coia JE
OBJECTIVES: The objective of this study was to characterise the epidemiology of C.difficile in Scotland by determining the distribution of PCR ribotypes and antimicrobial susceptibility in 1613 isolates collected from all healthboard areas of Scotland in the period November 2007- December 2009. METHODS: We performed PCR ribotyping and antimicrobial susceptibility testing by Etest on 1613 isolates from severe cases and outbreaks of CDI in all parts of Scotland between 2007-2009, and compared resistance profiles in the 10 most common ribotypes with those of the less common ribotypes. We further determined the local distribution of ribotypes in Scottish healthboard areas and correlated those to the local incidence rates of Clostridium difficile infection. RESULTS: Ribotypes 106 (29.4%), 001 (22.0%) and 027 (12.6%) were predominant types - other ribotypes included 002, 005, 014, 015, 020, 023 and 078. The ribotypes varied between healthboards. Antimicrobial susceptibility testing of C. difficile isolates showed high frequencies of resistance to moxifloxacin, levofloxacin, erythromycin and cefotaxime in the epidemic C. difficile ribotypes 001, 027 and 106 compared to other less common ribotypes. Furthermore, reduced susceptibility to metronidazole was found only in the epidemic strains. CONCLUSIONS: These findings are compatible with the hypothesis that fluoroquinolones, macrolides and cephalosporins may play a role in the spread of C. difficile in Scotland, while the role of metronidazole needs further investigations, and highlights the role of antimicrobial stewardship in preventing and controlling Clostridium difficile infection (CDI).
PMID: 21300104 [PubMed - as supplied by publisher]