Antimicrobial susceptibility and mechanisms of resistance of Greek Clostridium difficile clinical isolates

•First study on antimicrobial susceptibility of Greek Clostridium difficile isolates.•45.5% of strains were multidrug-resistant and the majority belonged to ST11 and ST37.•Mutations in gyrA, gyrB and rpoB were associated with ST11 and ST37.•Several genes conferring antimicrobial resistance were dete...

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Published in:	Journal of global antimicrobial resistance. Vol. 16; pp. 53 - 58
Main Authors:	Chatedaki, C., Voulgaridi, I., Kachrimanidou, M., Hrabak, J., Papagiannitsis, C.C., Petinaki, E.
Format:	Journal Article
Language:	English
Published:	Netherlands Elsevier Ltd 01-03-2019
Subjects:	Anti-Bacterial Agents - pharmacology Bacterial Proteins - genetics Bacterial Typing Techniques cfrC Clostridium difficile - classification Clostridium difficile - drug effects Clostridium difficile - genetics Clostridium Infections - microbiology Drug Resistance, Multiple, Bacterial - genetics ermB Greece Hospitals Humans Microbial Sensitivity Tests Multilocus Sequence Typing Mutation ST11 ST37 Tn6218 Greece cfrC Tn6218 ST37 ermB ST11
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Summary:	•First study on antimicrobial susceptibility of Greek Clostridium difficile isolates.•45.5% of strains were multidrug-resistant and the majority belonged to ST11 and ST37.•Mutations in gyrA, gyrB and rpoB were associated with ST11 and ST37.•Several genes conferring antimicrobial resistance were detected.•A new plasmid carrying the cfrC gene was identified. This study examined the antimicrobial susceptibility and resistance mechanisms of Clostridium difficile recovered in Greek hospitals during 2012–2015. C. difficile isolates (n=88) were collected from clinically-confirmed C. difficile infection from symptomatic patients in 10 Greek hospitals. Minimum inhibitory concentrations (MICs) of various antimicrobial agents were determined by Etest. Isolates were typed by multilocus sequence typing (MLST). Toxin and resistance genes were detected by PCR. Chromosomal mutations in gyrA, gyrB and rpoB were identified by PCR and sequencing. The genetic environment of resistance genes was characterised by Illumina sequencing. The 88 C. difficile isolates comprised 27 sequence types (STs), with ST37 (n=26) and ST11 (n=21) being the most prevalent. All isolates were susceptible to vancomycin and metronidazole, with variable resistance rates to other antimicrobials. Of the 88 isolates, 45.5% were multidrug-resistant and the majority belonged to ST11 and ST37. The presence of chromosomal mutations in gyrA, gyrB and rpoB was mainly observed in high-risk clones such as ST11 and ST37. The antimicrobial resistance genes ermB, mefA, msrA and tetM were identified at different prevalences and combinations. Additionally, cfrB and cfrC were identified for the first time in Greece and were carried by a Tn6218 transposon and a novel plasmid, respectively. To our knowledge, this is the first study examining the resistance profiles and respective mechanisms of C. difficile recovered in Greek hospitals. Gut commensals such as C. difficile may serve as hubs for further transfer of antimicrobial resistance genes.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2213-7165 2213-7173
DOI:	10.1016/j.jgar.2018.09.009