Molecular types and antimicrobial susceptibility patterns of Clostridium difficile isolates in different epidemiological settings in a tertiary care center in Israel

- A microbiological study of C. difficile isolates according to acquisition.
- The ribotype-027 was most common in the community-onset, hospital-acquired group.
- The SlpA hr-05 type was more common in the community-acquired group.
- Non-susceptibility to metronidazole or vancomycin was related to molecular type.
- Non-susceptibility to metronidazole/vancomycin was found in 4/7 of re-infections.

The aims of this prospective study were to examine the correlation between the molecular types and the antimicrobial susceptibility patterns of Clostridium difficile isolates with the source of acquisition and the occurrence of C. difficile infections (CDI) in a tertiary center in Israel. All available isolates from community-acquired (CA) CDI episodes (n = 43) and matching numbers of isolates from community-onset, hospital acquired (CO-HA, n = 67) and HA-CDI (n = 56) and 32 cases of recurrent CDI were typed and tested for susceptibility to vancomycin and metronidazole. The most common types were SlpA hr-02 (21%), SlpA hr-05/PCR-ribotype-014 (12%), PCR-ribotype-027 (10%) and SlpA cr-02 (10%). The PCR-ribotype-027 was most common in the CO-HA group and the hr-05 type was more common in the CA group. Non-susceptibility to metronidazole and/or vancomycin was found in 4/7 of re-infection isolates. Our study shows that CA-CDI is uncommon and is caused by similar strains as HA-CDI, albeit with different rates.