Predominance and high antibiotic resistance of the emerging Clostridium difficile genotypes NAPCR1 and NAP9 in a Costa Rican hospital over a 2-year period without outbreaks

Clostridium difficile is the major causative agent of nosocomial antibiotic-associated diarrhea. In a 2009 outbreak of C. difficileassociated diarrhea that was recorded in a major Costa Rican hospital, the hypervirulent NAP1 strain (45%) predominated together with a local genotype variant (NAPCR1, 3...

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Autores Principales: López Ureña, Diana, Quesada Gómez, Carlos, Montoya Ramírez, Mónica, Gamboa Coronado, María del Mar, Somogyi Pérez, Teresa, Rodríguez Sánchez, César, Rodríguez Cavallini, Evelyn
Formato: Artículo
Idioma: Inglés
Publicado: 2018
Materias:
Acceso en línea: https://www.nature.com/articles/emi201638
https://hdl.handle.net/10669/75162
id 75162
recordtype dspace
spelling 751622021-04-12T15:22:43Z Predominance and high antibiotic resistance of the emerging Clostridium difficile genotypes NAPCR1 and NAP9 in a Costa Rican hospital over a 2-year period without outbreaks López Ureña, Diana Quesada Gómez, Carlos Montoya Ramírez, Mónica Gamboa Coronado, María del Mar Somogyi Pérez, Teresa Rodríguez Sánchez, César Rodríguez Cavallini, Evelyn Antibiotic resistance Costa Rica Emerging Clostridium difficile NAPCR1 NAP9 589.95 Clostridium Clostridium difficile is the major causative agent of nosocomial antibiotic-associated diarrhea. In a 2009 outbreak of C. difficileassociated diarrhea that was recorded in a major Costa Rican hospital, the hypervirulent NAP1 strain (45%) predominated together with a local genotype variant (NAPCR1, 31%). Both strains were fluoroquinolone-resistant and the NAPCR1 genotype, in addition, was resistant to clindamycin and rifampicin. We now report on the genotypes and antibiotic susceptibilities of 68C. difficile isolates from a major Costa Rican hospital over a 2-year period without outbreaks. In contrast to our previous findings, no NAP1 strains were detected, and for the first time in a Costa Rican hospital, a significant fraction of the isolates were NAP9 strains (n = 14, 21%). The local NAPCR1 genotype remained prevalent (n = 18, 26%) and coexisted with 14 strains (21%) of classic hospital NAP types (NAP2, NAP4, and NAP6), eight new genotypes (12%), four environmental strains classified as NAP10 or NAP11 (6%), three strains without NAP designation (4%) and seven non-toxigenic strains (10%). All 68 strains were resistant to ciprofloxacin, 88% were resistant to clindamycin and 50% were resistant to moxifloxacin and rifampicin. Metronidazole and vancomycin susceptibilities were universal. The NAPCR1 and NAP9 strains, which have been associated with more severe clinical infections, were more resistant to antibiotics than the other strains. Altogether, our results confirm that the epidemiology of C. difficile infection is dynamic and that A−B+ strains from the NAP9 type are on the rise not only in the developed world. Moreover, our results reveal that the local NAPCR1 strains still circulate in the country without causing outbreaks but with equally high antibiotic-resistance rates and levels UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias de la Salud::Centro de Investigación en Enfermedades Tropicales (CIET) UCR::Vicerrectoría de Docencia::Salud::Facultad de Microbiología 2018-07-05T19:22:25Z 2018-07-05T19:22:25Z 2016-05 2018-06-06T14:53:25Z artículo original https://www.nature.com/articles/emi201638 2222-1751 https://hdl.handle.net/10669/75162 10.1038/emi.2016.38 803-B1-654 803-B3-003 en_US application/pdf Emerging Microbes & Infections, Vol 5, pp 1-5
institution Universidad de Costa Rica
collection Repositorio KERWA
language Inglés
topic Antibiotic resistance
Costa Rica
Emerging Clostridium difficile
NAPCR1
NAP9
589.95 Clostridium
spellingShingle Antibiotic resistance
Costa Rica
Emerging Clostridium difficile
NAPCR1
NAP9
589.95 Clostridium
López Ureña, Diana
Quesada Gómez, Carlos
Montoya Ramírez, Mónica
Gamboa Coronado, María del Mar
Somogyi Pérez, Teresa
Rodríguez Sánchez, César
Rodríguez Cavallini, Evelyn
Predominance and high antibiotic resistance of the emerging Clostridium difficile genotypes NAPCR1 and NAP9 in a Costa Rican hospital over a 2-year period without outbreaks
description Clostridium difficile is the major causative agent of nosocomial antibiotic-associated diarrhea. In a 2009 outbreak of C. difficileassociated diarrhea that was recorded in a major Costa Rican hospital, the hypervirulent NAP1 strain (45%) predominated together with a local genotype variant (NAPCR1, 31%). Both strains were fluoroquinolone-resistant and the NAPCR1 genotype, in addition, was resistant to clindamycin and rifampicin. We now report on the genotypes and antibiotic susceptibilities of 68C. difficile isolates from a major Costa Rican hospital over a 2-year period without outbreaks. In contrast to our previous findings, no NAP1 strains were detected, and for the first time in a Costa Rican hospital, a significant fraction of the isolates were NAP9 strains (n = 14, 21%). The local NAPCR1 genotype remained prevalent (n = 18, 26%) and coexisted with 14 strains (21%) of classic hospital NAP types (NAP2, NAP4, and NAP6), eight new genotypes (12%), four environmental strains classified as NAP10 or NAP11 (6%), three strains without NAP designation (4%) and seven non-toxigenic strains (10%). All 68 strains were resistant to ciprofloxacin, 88% were resistant to clindamycin and 50% were resistant to moxifloxacin and rifampicin. Metronidazole and vancomycin susceptibilities were universal. The NAPCR1 and NAP9 strains, which have been associated with more severe clinical infections, were more resistant to antibiotics than the other strains. Altogether, our results confirm that the epidemiology of C. difficile infection is dynamic and that A−B+ strains from the NAP9 type are on the rise not only in the developed world. Moreover, our results reveal that the local NAPCR1 strains still circulate in the country without causing outbreaks but with equally high antibiotic-resistance rates and levels
format Artículo
author López Ureña, Diana
Quesada Gómez, Carlos
Montoya Ramírez, Mónica
Gamboa Coronado, María del Mar
Somogyi Pérez, Teresa
Rodríguez Sánchez, César
Rodríguez Cavallini, Evelyn
author_sort López Ureña, Diana
title Predominance and high antibiotic resistance of the emerging Clostridium difficile genotypes NAPCR1 and NAP9 in a Costa Rican hospital over a 2-year period without outbreaks
title_short Predominance and high antibiotic resistance of the emerging Clostridium difficile genotypes NAPCR1 and NAP9 in a Costa Rican hospital over a 2-year period without outbreaks
title_full Predominance and high antibiotic resistance of the emerging Clostridium difficile genotypes NAPCR1 and NAP9 in a Costa Rican hospital over a 2-year period without outbreaks
title_fullStr Predominance and high antibiotic resistance of the emerging Clostridium difficile genotypes NAPCR1 and NAP9 in a Costa Rican hospital over a 2-year period without outbreaks
title_full_unstemmed Predominance and high antibiotic resistance of the emerging Clostridium difficile genotypes NAPCR1 and NAP9 in a Costa Rican hospital over a 2-year period without outbreaks
title_sort predominance and high antibiotic resistance of the emerging clostridium difficile genotypes napcr1 and nap9 in a costa rican hospital over a 2-year period without outbreaks
publishDate 2018
url https://www.nature.com/articles/emi201638
https://hdl.handle.net/10669/75162
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