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Molecular characterization, toxin detection and resistance testing of human clinical Clostridium difficile isolates from Lebanon.
Int J Med Microbiol. 2018 Apr; 308(3):358-363.IJ

Abstract

Clostridium (Clostridioides) difficile is the main cause for nosocomial diarrhoea in industrialised nations. Epidemiologic data on the pathogen's occurrence in other world regions are still scarce. In this context we characterized with phenotypic and molecular genetic methods C. difficile isolates stemming from hospitalised patients with diarrhoea in Lebanon. From 129 stool samples of symptomatic patients at a tertiary care University hospital in Lebanon, a total of 107 C. difficile strains were cultivated and underwent ribotyping, toxin gene detection and antibiotic resistance testing. Ribotype 014 (RT014, 16.8%) predominated, followed by RT002 (9.3%), RT106 (8.4%) and RT070 (6.5%). Binary toxin gene-positive isolates (RT023, RT078 and RT126) were rarely detected and RT027 was absent. Interestingly, within one isolate only the toxin A gene (tcdA) was detected. Multiple-locus variable-number tandem repeat analysis (MLVA) revealed strong strain diversity in most RTs. The isolates were sensitive to metronidazole and vancomycin, and only a small proportion of strains displayed resistance against moxifloxacin, rifampicin, and clarithromycin (5.6%, 1.9%, and 2.8%), respectively. The data indicate that the genetic strain composition of Lebanese strains differs markedly from the situation seen in Europe and North America. Especially the epidemic RTs seen in the latter regions were almost absent in Lebanon. Interestingly, most strains showed almost no resistance to commonly used antibiotics that are suspected to play a major role in the development of C. difficile infection, despite frequent use of these antibiotics in Lebanon. Thus, the role of antimicrobial resistance as a major driving force for infection development remains uncertain in this area.

Authors+Show Affiliations

Institute of Medical Microbiology and Hygiene, National Reference Laboratory for Clostridium difficile, Saarland University, Kirrberger Straβe, Building 43, 66421 Homburg/Saar, Germany. Electronic address: fabian.berger@uks.eu.Center for Infectious Diseases Research, American University of Beirut Medical Center, Riad El-Solh 1107, 2020, Beirut, Lebanon; Department of Experimental Pathology, Immunology, and Microbiology, American University of Beirut Medical Center, Riad El-Solh 1107, 2020, Beirut, Lebanon.Center for Infectious Diseases Research, American University of Beirut Medical Center, Riad El-Solh 1107, 2020, Beirut, Lebanon; Department of Pathology and Lab Medicine, American University of Beirut Medical Center, Riad El-Solh 1107, 2020, Beirut, Lebanon.Center for Infectious Diseases Research, American University of Beirut Medical Center, Riad El-Solh 1107, 2020, Beirut, Lebanon; Department of Pathology and Lab Medicine, American University of Beirut Medical Center, Riad El-Solh 1107, 2020, Beirut, Lebanon.Department of Internal Medicine, American University of Beirut Medical Center, Riad El-Solh 1107, 2020, Beirut, Lebanon.Department of Internal Medicine, American University of Beirut Medical Center, Riad El-Solh 1107, 2020, Beirut, Lebanon.Department of Internal Medicine, American University of Beirut Medical Center, Riad El-Solh 1107, 2020, Beirut, Lebanon.Center for Infectious Diseases Research, American University of Beirut Medical Center, Riad El-Solh 1107, 2020 Beirut, Lebanon.Institute of Medical Microbiology and Hygiene, National Reference Laboratory for Clostridium difficile, Saarland University, Kirrberger Straβe, Building 43, 66421 Homburg/Saar, Germany; Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; University of Basel, P.O. Box, CH-4003 Basel, Switzerland.Institute of Medical Microbiology and Hygiene, National Reference Laboratory for Clostridium difficile, Saarland University, Kirrberger Straβe, Building 43, 66421 Homburg/Saar, Germany; Institute for Laboratory Medicine, Microbiology and Hygiene, Christophorus Kliniken, Südwall 22, 48653, Coesfeld, Germany.Institute of Medical Microbiology and Hygiene, National Reference Laboratory for Clostridium difficile, Saarland University, Kirrberger Straβe, Building 43, 66421 Homburg/Saar, Germany.Center for Infectious Diseases Research, American University of Beirut Medical Center, Riad El-Solh 1107, 2020, Beirut, Lebanon; Department of Experimental Pathology, Immunology, and Microbiology, American University of Beirut Medical Center, Riad El-Solh 1107, 2020, Beirut, Lebanon.Institute of Medical Microbiology and Hygiene, National Reference Laboratory for Clostridium difficile, Saarland University, Kirrberger Straβe, Building 43, 66421 Homburg/Saar, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29478838

Citation

Berger, Fabian K., et al. "Molecular Characterization, Toxin Detection and Resistance Testing of Human Clinical Clostridium Difficile Isolates From Lebanon." International Journal of Medical Microbiology : IJMM, vol. 308, no. 3, 2018, pp. 358-363.
Berger FK, Rasheed SS, Araj GF, et al. Molecular characterization, toxin detection and resistance testing of human clinical Clostridium difficile isolates from Lebanon. Int J Med Microbiol. 2018;308(3):358-363.
Berger, F. K., Rasheed, S. S., Araj, G. F., Mahfouz, R., Rimmani, H. H., Karaoui, W. R., Sharara, A. I., Dbaibo, G., Becker, S. L., von Müller, L., Bischoff, M., Matar, G. M., & Gärtner, B. (2018). Molecular characterization, toxin detection and resistance testing of human clinical Clostridium difficile isolates from Lebanon. International Journal of Medical Microbiology : IJMM, 308(3), 358-363. https://doi.org/10.1016/j.ijmm.2018.01.004
Berger FK, et al. Molecular Characterization, Toxin Detection and Resistance Testing of Human Clinical Clostridium Difficile Isolates From Lebanon. Int J Med Microbiol. 2018;308(3):358-363. PubMed PMID: 29478838.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Molecular characterization, toxin detection and resistance testing of human clinical Clostridium difficile isolates from Lebanon. AU - Berger,Fabian K, AU - Rasheed,Sari S, AU - Araj,George F, AU - Mahfouz,Rami, AU - Rimmani,Hussein H, AU - Karaoui,Walid R, AU - Sharara,Ala I, AU - Dbaibo,Ghassan, AU - Becker,Sören L, AU - von Müller,Lutz, AU - Bischoff,Markus, AU - Matar,Ghassan M, AU - Gärtner,Barbara, Y1 - 2018/02/22/ PY - 2017/11/07/received PY - 2018/01/09/revised PY - 2018/01/19/accepted PY - 2018/2/27/pubmed PY - 2018/11/22/medline PY - 2018/2/27/entrez KW - BI/NAP1/027 KW - Distribution KW - Epidemiology KW - MLST KW - Middle East KW - Prevalence SP - 358 EP - 363 JF - International journal of medical microbiology : IJMM JO - Int J Med Microbiol VL - 308 IS - 3 N2 - Clostridium (Clostridioides) difficile is the main cause for nosocomial diarrhoea in industrialised nations. Epidemiologic data on the pathogen's occurrence in other world regions are still scarce. In this context we characterized with phenotypic and molecular genetic methods C. difficile isolates stemming from hospitalised patients with diarrhoea in Lebanon. From 129 stool samples of symptomatic patients at a tertiary care University hospital in Lebanon, a total of 107 C. difficile strains were cultivated and underwent ribotyping, toxin gene detection and antibiotic resistance testing. Ribotype 014 (RT014, 16.8%) predominated, followed by RT002 (9.3%), RT106 (8.4%) and RT070 (6.5%). Binary toxin gene-positive isolates (RT023, RT078 and RT126) were rarely detected and RT027 was absent. Interestingly, within one isolate only the toxin A gene (tcdA) was detected. Multiple-locus variable-number tandem repeat analysis (MLVA) revealed strong strain diversity in most RTs. The isolates were sensitive to metronidazole and vancomycin, and only a small proportion of strains displayed resistance against moxifloxacin, rifampicin, and clarithromycin (5.6%, 1.9%, and 2.8%), respectively. The data indicate that the genetic strain composition of Lebanese strains differs markedly from the situation seen in Europe and North America. Especially the epidemic RTs seen in the latter regions were almost absent in Lebanon. Interestingly, most strains showed almost no resistance to commonly used antibiotics that are suspected to play a major role in the development of C. difficile infection, despite frequent use of these antibiotics in Lebanon. Thus, the role of antimicrobial resistance as a major driving force for infection development remains uncertain in this area. SN - 1618-0607 UR - https://www.unboundmedicine.com/medline/citation/29478838/Molecular_characterization_toxin_detection_and_resistance_testing_of_human_clinical_Clostridium_difficile_isolates_from_Lebanon_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1438-4221(17)30556-8 DB - PRIME DP - Unbound Medicine ER -