Clostridium difficile infection (CDI) affects significant numbers of hospitalized patients and is an increasing problem in the community. It is also among the most commonly isolated pathogens in... Show moreClostridium difficile infection (CDI) affects significant numbers of hospitalized patients and is an increasing problem in the community. It is also among the most commonly isolated pathogens in HIV patients with diarrheal illness and is >= 2 fold more common in HIV-seropositive individuals. This association is stronger in those with low absolute CD4 T cell counts or meeting clinical criteria for an AIDS diagnosis, and was most pronounced before the wide availability of highly active antiretroviral therapy. The presentation and outcome of CDI in HIV appears similar to the general population. The increased risk can in part be attributed to increased hospitalization and antimicrobial use, but HIV related alterations in fecal microbiota, gut mucosal integrity, and humoral and cell mediated immunity are also likely to play a role. Here we review the evidence for these observations and the relevance of recent advances in the diagnosis and management of CDI for the HIV clinician. Show less
Clostridium difficile is one of the most important causative agents of severe diarrhoea in hospitalised patients treated with antibiotics. Since 2008, Bulgaria participated in the Pan-European... Show moreClostridium difficile is one of the most important causative agents of severe diarrhoea in hospitalised patients treated with antibiotics. Since 2008, Bulgaria participated in the Pan-European Surveillance Study investigating the prevalence of C. difficile infections (CDI) in different European countries. In the period November 2008 - March 2010, the incidence of CDI in nine participating hospitals was 7.94 per 10 000 patient admissions (0.34 per 10 000 patient-days). In total, sixty five fecal samples from patients with mild to severe enterocolitis and previous antibiotic treatment were investigated for CDI. Strains were typed and further characterized for the presence of toxins A (TcdA), B (TcdB) and binary toxins (CdtA and CdtB). Of 65 stool samples included, 15 were toxin and culture positive for C. difficile. Six of the isolates (40%) belonged to PCR ribotype 017 (TcdA(-).; TcdB(+); CdtA/B-), followed by 002 (n = 2 isolates) and 014 (n = 2 isolates). The remaining C. difficile isolates were typed as 012 (n = 1), 046 (n = 1), 078 ribotypes (n = 1) and 2 isolates were untypable. In conclusion, after the Pan-European surveillance study, a laboratory-based surveillance of CDI has been introduced in Bulgaria. The most prevalent C. difficile ribotype in Bulgaria was 017 (40%). All determined PCR ribotypes were found to be associated with severe CDI and a high percentage of lethal outcomes, indicating that improvements of surveillance with appropriate clinical and epidemiological criteria is warranted. Show less
Background: Antimicrobial use is recognized as a risk factor for Clostridium difficile infection (CDI) and outbreaks. We studied the relationship between PCR ribotype, antimicrobial susceptibility... Show moreBackground: Antimicrobial use is recognized as a risk factor for Clostridium difficile infection (CDI) and outbreaks. We studied the relationship between PCR ribotype, antimicrobial susceptibility and the genetic basis of resistance in response to exposure to antimicrobial agents. Methods: C. difficile isolates were cultured from 133 CDI patients for whom recent antimicrobial drug exposure had been recorded. Isolates were ribotyped by PCR and assessed for their susceptibility to the macrolide-lincosamide-streptogramin B (MLSB) group of compounds (erythromycin and clindamycin) and fluoroquinolone antimicrobials (ciprofloxacin, levofloxacin and moxifloxacin). Where relevant, the genetic basis of resistance was determined. Results: Prevalent ribotypes (including 027, 001 and 106) exhibited significantly greater antimicrobial resistance compared with ribotypes 078 and 014, among others. Clindamycin-resistant ribotype 078 was detected for the first time. Ribotypes 027 and 001 were more likely to exhibit MLSB resistance, a feature that was associated with the erm(B) gene. Exposure to MLSB or fluoroquinolone antimicrobial compounds in the 8 weeks prior to the onset of infection was not associated with specific genetic markers of resistance. Single amino acid substitutions in the A and B subunits of DNA gyrase were noted and were ribotype specific and linked to resistance to moxifloxacin. Conclusions: Resistance to MLSB and fluoroquinolone antimicrobial compounds is common among prevalent ribotypes of C. difficile. The genetic basis for antimicrobial resistance appears to be ribotype specific and conserved in the absence of recent antimicrobial selection pressure. Show less
