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Multicenter Study
. 2020 Jun 30;9(1):98.
doi: 10.1186/s13756-020-00765-y.

The association of a reduced susceptibility to moxifloxacin in causative Clostridium (Clostridioides) difficile strain with the clinical outcome of patients

Marcela Krutova  1 , Vaclav Capek  2 , Elka Nycova  3 , Sabina Vojackova  4 , Magda Balejova  5 , Lenka Geigerova  6 , Renata Tejkalova  7 , Lenka Havlinova  8 , Iva Vagnerova  9 , Pavel Cermak  10 , Lenka Ryskova  11 , Petr Jezek  12 , Dana Zamazalova  13 , Denisa Vesela  14 , Alice Kucharova  15 , Dana Nemcova  16 , Martina Curdova  17 , Otakar Nyc  18 , Pavel Drevinek  18
Affiliations
Multicenter Study

The association of a reduced susceptibility to moxifloxacin in causative Clostridium (Clostridioides) difficile strain with the clinical outcome of patients

Marcela Krutova et al. Antimicrob Resist Infect Control. .

Abstract

Objectives: To investigate the relationship between Clostridium (Clostridioides) difficile strain characteristics and C. difficile infection (CDI) outcome.

Methods: Between October and December 2017, 16 hospitals collected epidemiological data according to the European Centre for Disease Prevention and Control (ECDC) surveillance protocol for CDI. C. difficile isolates were characterized by ribotyping, toxin genes detection and antibiotic susceptibility testing to metronidazole, vancomycin and moxifloxacin.

Results: The overall mean CDI incidence density was 4.5 [95% CI 3.6-5.3] cases per 10,000 patient-days. From the 433 CDI cases, 330 (76.2%) were healthcare-associated, 52 (12.0%) cases were community-associated or of unknown origin and 51 (11.8%) CDI cases recurrent; a complicated course of CDI was reported in 65 cases (15.0%). Eighty-eight (20.3%) of patients died and 59 of them within 30 days after the CDI diagnosis. From the 379 C. difficile isolates, the most prevalent PCR ribotypes were 001 (n = 127, 33.5%) and 176 (n = 44, 11.6%). A total of 186 (49.1%) isolates showed a reduced susceptibility to moxifloxacin (> 4 mg/L) and 96.4% of them had Thr82Ile in the GyrA. Nineteen isolates revealed reduced susceptibility to metronidazole and two isolates to vancomycin (> 2 mg/L). A fatal outcome was associated with a reduced susceptibility to moxifloxacin, the advanced age of the patients and a complicated course of CDI (p<0.05). No association between ribotype, binary toxin and a reduced susceptibility to moxifloxacin and complicated course or recurrent CDI was found.

Conclusions: A reduced susceptibility to moxifloxacin, in causative C. difficile strains was associated with fatal outcome of the patients, therefore it is an important marker in surveillance of CDI.

Keywords: Clostridioides difficile infection; Clostridium difficile infection; Czech Republic; Mortality; Moxifloxacin; PCR ribotype 001; PCR ribotype 176.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

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