Fluoroquinolone Resistance and Clostridium difficile, Germany

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Volume 16, Number 4–April 2010
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Fluoroquinolone Resistance and Clostridium difficile, Germany
Nils Henning Zaiß, Wolfgang Witte, and Ulrich Nübel
Author affiliation: Robert Koch Institute, Wernigerode, Germany

Suggested citation for this article

Abstract
We characterized 670 Clostridium difficile isolates collected from patients in 84 hospitals in Germany in 2008. PCR ribotyping showed high prevalence of ribotype 001 and restricted dissemination of ribotype 027 strains. Fluoroquinolone resistance and associated gyrase mutations were frequent in various ribotypes, but no resistance to metronidazole or vancomycin was noted.

During the past decade, incidence rates of Clostridium difficile infections (CDI) have increased noticeably worldwide (1). In the United States and Canada, this increase has been associated with the emergence of a possibly more virulent strain designated North American pulsotype 1 (NAP1), or PCR ribotype 027. Strains with identical typing patterns have also been reported from several countries in Europe (1). In Germany, the first clusters of infections with C. difficile ribotype 027 were identified in the southwest region in 2007 (2,3). Although incidence rates increased in Germany after 2000 (4), an association with particular strains remains unclear, and no nationwide surveillance data on C. difficile genotype prevalence exist.

We report the distribution and associated antimicrobial drug susceptibility of prevalent C. difficile strains in Germany. Isolates were characterized by PCR ribotyping (5) by using the ribotype nomenclature of the Cardiff Anaerobe Reference Laboratory (Cardiff, Wales, UK). Antimicrobial drug susceptibility to therapeutic drugs (metronidazole and vancomycin) and to fluoroquinolones (moxifloxacin and levofloxacin) was determined by using the Etest method (breakpoints according to European Committee on Antimicrobial Susceptibility Testing guidelines).

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Suggested Citation for this Article
Zaiß NH, Witte W, Nübel U. Fluoroquinolone resistance and Clostridium difficile, Germany. Emerg Infect Dis [serial on the Internet]. 2010 April [date cited]. http://www.cdc.gov/EID/content/16/4/675.htm

DOI: 10.3201/eid1604.090859