Appearance of Clostridium difficile infections in health care institutions in Slovakia and in the district of martin

Diagnostic Methods of Clostridioides difficile Infection and Clostridioides difficile Ribotypes in Studied Sample

BACKGROUND

Clostridioides (Clostridium) difficile is the most common nosocomial pathogen and antibiotic-related diarrhea in health-care facilities. Over the last few years, there was an increase in the incidence rate of C. difficile infection cases in Slovakia. In this study, the phenotypic (toxigenicity, antimicrobial susceptibility) and genotypic (PCR ribotypes, genes for binary toxins) patterns of C. difficile isolates from patients with CDI were analyzed, from July to August 2016, taken from hospitals in the Horne Povazie region of northern Slovakia. The aim of the study was also to identify hypervirulent strains (e.g., the presence of RT027 or RT176).

METHODS

The retrospective analysis of biological samples suspected of CDI were analyzed by GDH, anaerobic culture, enzyme immunoassay on toxins A/B, multiplex "real-time" PCR and PCR capillary-based electrophoresis ribotyping, and by MALDI TOF MS.

RESULTS

C. difficile isolates (n = 44) were identified by PCR ribotyping, which revealed five different ribotypes (RT001, 011, 017, 081, 176). The presence of hypervirulent RT027 was not identified. The C. difficile isolates (RT001, 011, 081, 176) were susceptible to metronidazole and vancomycin. One isolate RT017 had reduced susceptibility to vancomycin. A statistically significant difference between the most prevalent PCR ribotypes, RT001 and RT176, regarding variables such as albumin, CRP, creatinine, the length of hospitalization (p = 0.175), and glomerular filtration (p = 0.05) was not found.

CONCLUSION

The results of PCR capillary-based electrophoresis ribotyping in the studied samples showed a high prevalence of RT176 and 001.

New Approaches to Diagnostics of C.Difficile Infection

Introduction: Clostridium difficile infection (CDI) is the most common infectious cause of diarrhoea in hospitalised patients. It is a severe issue with increasing incidence in healtcare facilities and commmunities. Early and appropriate testing of CDI is very imortant. There are many different approaches that can be used in the CDI laboratory diagnostics. Recently performed studies evaluated diagnostic algorithms to optimize laboratory CDI diagnostics. The aim of the work was to implement an optimal algorithm of testing methods in CDI diagnostics.

Materials and methods: The retrospective analysis of patients’ samples suspected on CDI was carried out in 2017. The data was analysed from the Laboratory Klinicka Biochemia in Zilina. The application of ESCMID re -commendation criteria for algorithm of testing, together with procedures in laboratory practice was carried out.

Results: The analysis of the data showed that the applied algorithm or testing in CDI and highlighted the importance of preanalytic phase, and the evaluation of testing methods and results, together with clinical findings. Two- and three- step algorithm together with cultivation methods were applied. 87,6% of samples could be eva -luated with positive or negative results according to the 2-step algorhitm. Further samples were assessed and tested by ELISA test or PCR method.

Conclusion: CDI represents a significant burden in healthcare facilities. An early diagnostics and interpretation helps to start the early treatment and helps in surveillence of the infection.