OBJECTIVES: To investigate the relationship between Clostridium (Clostridioides) difficile strain characteristics and C. difficile infection (CDI) outcome. METHODS: Between October and December 2017, 16 hospitals collected epidemiological data according to the European Centre for Disease Prevention and Control (ECDC) surveillance protocol for CDI. C. difficile isolates were characterized by ribotyping, toxin genes detection and antibiotic susceptibility testing to metronidazole, vancomycin and moxifloxacin. RESULTS: The overall mean CDI incidence density was 4.5 [95% CI 3.6-5.3] cases per 10,000 patient-days. From the 433 CDI cases, 330 (76.2%) were healthcare-associated, 52 (12.0%) cases were community-associated or of unknown origin and 51 (11.8%) CDI cases recurrent; a complicated course of CDI was reported in 65 cases (15.0%). Eighty-eight (20.3%) of patients died and 59 of them within 30 days after the CDI diagnosis. From the 379 C. difficile isolates, the most prevalent PCR ribotypes were 001 (n = 127, 33.5%) and 176 (n = 44, 11.6%). A total of 186 (49.1%) isolates showed a reduced susceptibility to moxifloxacin (> 4 mg/L) and 96.4% of them had Thr82Ile in the GyrA. Nineteen isolates revealed reduced susceptibility to metronidazole and two isolates to vancomycin (> 2 mg/L). A fatal outcome was associated with a reduced susceptibility to moxifloxacin, the advanced age of the patients and a complicated course of CDI (p<0.05). No association between ribotype, binary toxin and a reduced susceptibility to moxifloxacin and complicated course or recurrent CDI was found. CONCLUSIONS: A reduced susceptibility to moxifloxacin, in causative C. difficile strains was associated with fatal outcome of the patients, therefore it is an important marker in surveillance of CDI.

Bioinformatics centre 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Clinical Microbiology and Parasitology Hospital Pribram Pribram Czech Republic

Department of Clinical Microbiology Hospital Nove Mesto na Morave Nove Mesto na Morave Czech Republic

Department of Clinical Microbiology Institute for Clinical and Experimental Medicine Prague Czech Republic

Department of Clinical Microbiology Military University Hospital Prague Czech Republic

Department of Clinical Microbiology University Hospital Hradec Kralove Hradec Kralove Czech Republic

Department of Medical Microbiology and Immunology Hospital Liberec Liberec Czech Republic

Department of Medical Microbiology Charles University 2nd Faculty of Medicine and Motol University Hospital Prague Czech Republic

Department of Medical Microbiology Faculty of Medicine Charles University and University Hospital Plzen Plzen Czech Republic

Department of Medical Microbiology Faculty of Medicine Masaryk University and St Anne's University Hospital Brno Czech Republic

Department of Medical Microbiology Hospital Bulovka Prague Czech Republic

Department of Medical Microbiology Hospital Ceske Budejovice Ceske Budejovice Czech Republic

Department of Medical Microbiology Hospital Jindrichuv Hradec Jindrichuv Hradec Czech Republic

Department of Medical Microbiology Hospital Tabor Tabor Czech Republic

Department of Medical Microbiology Thomayer's Hospital Prague Czech Republic

Department of Medical Microbiology University Hospital Brno Brno Czech Republic

Department of Microbiology Faculty of Medicine and Dentistry Palacky University Hospital Olomouc Czech Republic

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