Clostridioides difficile surveillance at the University Hospital in Košice reveals high prevalence of the ribotype 176

Clostridioides difficile infection (CDI) has become a serious health problem worldwide in recent years, the severity of which lies in the ability to spread epidemically in hospitals and in frequent diseases relapses. CDI Surveillance was performed at the Louis Pasteur University Hospital in Košice from January to February 2020 to analyse the molecular characteristics ofC. difficile(CD) isolates from local patients with CDI.

CDI was initially diagnosed using the C. difficile rapid test (for enzyme GDH and toxin A/B). A total of 36 stool samples (29 GDH and toxin positive, 7 GDH positive and toxin negative) were cultured anaerobically on selective media (Brazier’s agar). Culture was positive for CD in 31 samples. Bacterial DNA was extracted from all CD isolates. Genes tcdA, tcdB, cdtA and cdtB encoding toxin A, toxin B and binary toxin were detected by multiplex PCR and ribotypes of CD were analysed by capillary electrophoresis-based PCR.

Molecular typing showed that toxin A as well as toxin B was confirmed in 30 of 31 isolates, binary toxin in 18 isolates. Ribotype 176, characterized by production of all 3 toxins, was the most prevalent and was detected in 18 isolates (58%). Toxin A and toxin B producing ribotypes 001, 014 and 020 were also confirmed.

The high incidence of epidemic ribotype 176 with higher capacity to spread in a hospital setting emphasises the need to implement strict epidemic measures and the importance of implementing continuous surveillance programmes for CDI in Slovakia.