Clostridioides difficile is the most common pathogen responsible for hospital-acquired diarrhea. This complication of antibiotic treatment mainly endangers the health of elder patients. Preventing the development of C. difficile infections (CDI) is still a challenge that needs to be addressed. In our study, the results of 872 C. difficile positive stool samples were used to describe the epidemiological situation affected by a change in the prescription of fluoroquinolone antibiotics. In a total, 93 of strains were typed by polymerase chain reaction (PCR) and capillary gel electrophoresis. Between years 2014 and 2018 the decline in the fluoroquinolones consumption was 69.3 defined daily dose (DDD) per 1000 patient-days (from 103.3 to 34.0), in same period CDI incidence declined by 1.3 cases per 10,000 patient-bed days (from 5.6 to 4.3). Results of epidemiologic and statistical analysis shows that decline in fluoroquinolones consumption has significant influence on CDI incidence and prevalence of hypervirulent strains. In the University Hospital Hradec Králové properly managed antibiotic stewardship policy has reduced CDI incidence by 23.2% and lowered rate of hypervirulent ribotypes 001 and 176.

Department of Clinical Microbiology and Imunology Regional Hospital Liberec 46001 Liberec Czech Republic

Department of Clinical Microbiology University Hospital and Faculty of Medicine in Hradec Kralove Charles University 50005 Hradec Kralove Czech Republic

Department of Microbiology 3rd Faculty of Medicine Charles University University Hospital Kralovske Vinohrady and National Institute of Public Health 10000 Prague Czech Republic

Faculty of Mechatronics Informatics and Interdisciplinary Studies Technical University of Liberec 46001 Liberec Czech Republic

Hospital Hygiene Department University Hospital Hradec Kralove 50005 Hradec Kralove Czech Republic

National Reference Laboratory for Antibiotics Centre for Epidemiology and Microbiology National Institute of Public Health 10000 Prague Czech Republic

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Lawson P.A., Citron D.M., Tyrrell K.L. Reclassification of Clostridium difficile as Clostridioides difficile (Hall and O’Toole 1935) Prévot 1938. Anaerobe. 2016;40:95–99. doi: 10.1016/j.anaerobe.2016.06.008. PubMed DOI

Khanafer N., Vanhems P., Barbut F., Eckert C., Perraud M., Vandenesch F., Luxemburger C., Demont C., CDI01 Study Group Outcomes of Clostridium difficile-suspected diarrhea in a French university hospital. Eur. J. Clin. Microbiol. Infect. Dis. 2018;37:2123–2130. doi: 10.1007/s10096-018-3348-x. PubMed DOI

Bauer M.P., Notermans D.W., van Benthem B.H., Brazier J.S., Wilcox M.H., Rupnik M., Monnet D.L., van Dissel J.T., Kuijper E.J., ECDIS Study Group Clostridium difficile infection in Europe: A hospital-based survey. Lancet. 2011;377:63–73. doi: 10.1016/S0140-6736(10)61266-4. PubMed DOI

Davies K.A., Longshaw C.M., Davis G.L., Bouza E., Barbut F., Barna Z., Delmée M., Fitzpatrick F., Ivanova K., Kuijper E., et al. Underdiagnosis of Clostridium difficile across Europe: The European, multicentre, prospective, biannual, point-prevalence study of Clostridium difficile infection in hospitalised patients with diarrhoea (EUCLID) Lancet Infect. Dis. 2014;14:1208–1219. doi: 10.1016/S1473-3099(14)70991-0. PubMed DOI

Krutova M., Matejkova J., Kuijper E., Drevinek P., Nyc O., Czech Clostridium Difficile Study Group Clostridium difficile PCR ribotypes 001 and 176—The common denominator of C. difficile infection epidemiology in the Czech Republic, 2014. Euro Surveill. 2016;21:29. doi: 10.2807/1560-7917.ES.2016.21.29.30296. PubMed DOI

Krutova M., Matejkova J., Drevinek P., Kuijper E.J., Nyc O., Study Group Increasing incidence of Clostridium difficile ribotype 001 associated with severe course of the infection and previous fluoroquinolone use in the Czech Republic, 2015. Eur. J. Clin. Microbiol. Infect. Dis. 2017;36:2251–2258. doi: 10.1007/s10096-017-3055-z. PubMed DOI

Krutova M., Matejkova J., Tkadlec J., Nyc O. Antibiotic profiling of Clostridium difficile ribotype 176-A multidrug resistant relative to C. difficile ribotype 027. Anaerobe. 2015;36:88–90. doi: 10.1016/j.anaerobe.2015.07.009. PubMed DOI

Spigaglia P., Barbanti F., Mastrantonio P. Multidrug resistance in European Clostridium difficile clinical isolates. J. Antimicrob. Chemother. 2011;66:2227–2234. doi: 10.1093/jac/dkr292. PubMed DOI

Valiente E., Dawson L.F., Cairns M.D., Stabler R.A., Wren B.W. Emergence of new PCR ribotypes from the hypervirulent Clostridium difficile 027 lineage. J. Med. Microbiol. 2012;61:49–56. doi: 10.1099/jmm.0.036194-0. PubMed DOI PMC

Goorhuis A.V.K.T., Van der Kooi T., Vaessen N., Dekker F.W., van den Berg R., Harmanus C., van den Hof S., Notermans D.W., Kuijper E.J. Spread and epidemiology of Clostridium difficile polymerase chain reaction ribotype 027/toxinotype III in The Netherlands. Clin. Infect. Dis. 2007;45:695–703. doi: 10.1086/520984. PubMed DOI

Nyc O., Urbaskova P., Marešová V., Prokeš M., Jindrák V., Švihovec J., Sechser T., Karen I., Hoza J. Konsensus používání antibiotik III. Chinolony. Prakt. Lékař. 2006;86:570–574.

Dingle K.E., Didelot X., Quan T.P., Eyre D.W., Stoesser N., Golubchik T., Harding R.M., Wilson D.J., Griffiths D., Vaughan A., et al. Effects of control interventions on Clostridium difficile infection in England: An observational study. Lancet Infect. Dis. 2017;17:P411–P421. doi: 10.1016/S1473-3099(16)30514-X. PubMed DOI PMC

Lawes T., Lopez-Lozano J.M., Nebot C.A., Macartney G., Subbarao-Sharma R., Wares K.D., Sinclair C., Gould I.M. Effect of a national 4C antibiotic stewardship intervention on the clinical and molecular epidemiology of Clostridium difficile infections in a region of Scotland: A non-linear time-series analysis. Lancet Infect. Dis. 2017;17:194–206. doi: 10.1016/S1473-3099(16)30397-8. PubMed DOI

Krutova M., Capek V., Nycova E., Vojackova S., Balejova M., Geigerova L., Tejkalova R., Havlinova L., Vagnerova I., Cermak P., et al. The association of a reduced susceptibility to moxifloxacin in causative Clostridium (Clostridioides) difficile strain with the clinical outcome of patients. Antimicrob. Resist. Infect. Control. 2020;9:98. doi: 10.1186/s13756-020-00765-y. PubMed DOI PMC

European Centre for Disease Prevention and Control . ECDC Annual Epidemiological Report for 2016. ECDC; Stockholm, Sweden: 2018. Healthcare-associated infections: Clostridium difficile infections.

Indra A., Huhulescu S., Schneeweis M., Hasenberger P., Kernbichler S., Fiedler A., Wewalka G., Allerberger F., Kuijper E.J. Characterization of Clostridium difficile isolates using capillary gel electrophoresis-based PCR ribotyping. J. Med. Microbiol. 2008;57:1377–1382. doi: 10.1099/jmm.0.47714-0. PubMed DOI PMC

RStudio Team . RStudio: Integrated Development for R. RStudio, Inc.; Boston, MA, USA: 2021. [(accessed on 17 April 2021)]. Available online: http://www.rstudio.com/

R Core Team . R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing; Vienna, Austria: 2021. [(accessed on 17 April 2021)]. Available online: http://www.R-project.org/

Kursa M.B., Rudnicki W.R. Feature Selection with the Boruta Package. J. Stat. Soft. 2010;36:1–13. doi: 10.18637/jss.v036.i11. DOI

Ribotyping of Clostridioides difficile in the Liberec Regional Hospital: a tertiary health care facility