Molecular detection of Clostridium difficile on inert surfaces from a Costa Rican hospital during and after an outbreak.

BACKGROUND: Hospital transmission of Clostridium difficile is fostered by contamination of surfaces and medical equipment with spores highly resistant to disinfectants and regular cleaning procedures. Despite the outbreaks and fatalities that C difficile causes, its epidemiology has not been studied in hospitals from middle- and low-income countries. To tackle this knowledge gap, the detection frequency of C difficile DNA on inert surfaces of a major Costa Rican hospital during and after an outbreak was compared. METHODS: We used a presence-absence real-time polymerase chain reaction to detect a fragment of the tpi gene of C difficile on 21 surface samples collected during an outbreak and 54 surface samples taken 2 years later at the same hospital. RESULTS: C difficile DNA was detected in 40% of the 75 environmental samples analyzed. Whereas 71% of the samples collected during the outbreak were positive, only 28% of the samples obtained 2 years after the outbreak gave the same result. This 2.5× ratio was maintained when the comparison was restricted to the wards that were sampled both during and after the outbreak (72% vs 35%, P = .016). CONCLUSIONS: Our results show that environmental surfaces in the hospital analyzed are continuously being contaminated with C difficile DNA and that their level of contamination is higher during an outbreak than after it.

Isolation of a toxigenic and clinical genotype of clostridium difficile in retail meats in Costa Rica.

We isolated a regional toxigenic genotype of Clostridium difficile, previously found in human infection in 4 of 200 (2%) samples of retail meats for human consumption: 1 of 67 samples of beef, 2 of 66 of pork, and 1 of 67 of poultry meat. These four isolates were positive for the tcdA and tcdB genes but negative for deletion of the tcdC and cdtB genes. All strains induced cytopathic effects in HeLa cells. However, they were susceptible to some antibiotics to which clinical isolates are often resistant. All strains were susceptible to vancomycin, metronidazole, moxifloxacin, and rifampicin but resistant to clindamycin and ciprofloxacin. This first report of isolation of C. difficile in foodstuff from Latin America lends support to the notion that animal products serve as a reservoir for clinical strains of this pathogen in the community.

Resistance of Bacteroides isolates recovered among clinical samples from a major Costa Rican hospital between 2000 and 2008 to ß-lactams, clindamycin, metronidazole, and chloramphenicol

Objetivo. Determinar la sensibilidad a varios ß-lactámicos, cloranfenicol, clindamicina y metronidazol de 100 aislamientos de Bacteroides spp. obtenidos en uno de los principales hospitales de Costa Rica entre 2000 y 2008. Métodos. Se utilizó el sistema ATB ANA® para determinar la sensibilidad a la amoxicilina, amoxicilina con ácido clavulánico, piperacilina, piperacilina con tazobactam, ticarcilina, ticarcilina con ácido clavulánico, cefoxitina, cefotetan, imipenem, cloranfenicol, clindamicina y metronidazol. Debido a la utilización en Costa Rica de clindamicina y metronidazol como tratamientos de elección para infecciones anaerobias, se determinó la concentración mínima inhibitoria (CMI) de ambas drogas con el método de microdilución en caldo. Las cepas ATCC 25285 y ATCC 29741 se utilizaron como referencia. Resultados. De acuerdo con el sistema ATB ANA®, 93 aislamientos fueron resistentes al menos a un antibiótico. La resistencia a los b-lactámicos fue frecuente, mientras que la resistencia a b-lactámicos con inhibidores de b-lactamasa fue escasa. Todas las cepas se inhibieron con imipenem y cloranfenicol. Con el método de microdilución en caldo, la resistencia a clindamicina fue del 20%, con CMI de 64 mg/La 256 mg/L; todas las cepas fueron sensibles a metronidazol. Conclusiones. La alta CMI de clindamicina de la mayoría de las cepas resistentes sugiere la presencia de mecanismos de resistencia adquiridos en los aislamientos, por lo que se requieren estudios de vigilancia epidemiológica para determinar su eficacia. La baja resistencia observadadel metronidazol destaca su valor como una droga de primera línea. Por otra parte, imipenem podría usarse para tratar infecciones que no responden bien a metronidazol o clindamicina(AU)

Objective. To assess the susceptibility of 100 isolates of Bacteroides spp. recovered in a major Costa Rican hospital between 2000 and 2008 to several ß-lactams, chloramphenicol, clindamycin and metronidazole. Methods. Susceptibility to amoxicillin, amoxicillin with clavulanic acid, piperacillin, piperacillin with tazobactam, ticarcillin, ticarcillin with clavulanic acid, cefoxitin, cefotetan, imipenem, chloramphenicol, clindamycin, and metronidazole was determined with the ATB ANA® system. In addition, minimum inhibitory concentrations (MIC) of clindamycin and metronidazole were determined with the broth microdilution method because these drugs are the treatment of choice for anaerobic infections in Costa Rica. Reference strains ATCC® 25285 and ATCC® 29741 were employed as indicated. Results. According to the ATB ANA® system, 93 isolates were resistant to at least one antibiotic. Resistance to b-lactams was common. By contrast, resistance to b-lactams supplemented with b-lactamase inhibitors was rare. All of the strains were inhibited by imipenem and chloramphenicol. By a broth microdilución test, resistance to clindamycin was 20%, with MIC ranging from 64 mg/L to 256 mg/L; all of the strains were susceptible to metronidazole. Conclusions. The high MIC for clindamycin obtained for the majority of the resistant strains is highly suggestive of the presence of mechanisms of acquired resistance among the isolates, therefore surveillance studies are required to determine its efficacy. The low resistance to metronidazole observed underlines its value as a first-line drug. On the other hand, imipenem could be used to treat infections that do not respond well to metronidazole or clindamycin(AU)

Community-acquired Clostridium difficile NAP1/027-associated diarrhea in an eighteen month old child.

Clostridium difficile infection (CDI), characterized by symptoms varying from diarrhea to life-threatening colitis, is a major complication of antibiotic therapy. Studies suggested that CDI is emerging as an important cause of childhood diarrhea in community and hospital settings. This work is the first report of a documented case of community-acquired CDI by a NAP1 hypervirulent strain in an eighteen month old child from Latin America.

Caracterización molecular y resistencia antimicrobiana de aislamientos de Clostridium perfringens de diferentes orígenes en Costa Rica

Molecular characterization and antimicrobial resistance of Clostridium perfringens isolates of different origins from Costa Rica. Clostridium perfringens, a Gram positive, spore-forming anaerobe, is widely distributed in nature. Based upon their production of four major toxins α, β, ε and ι, C. perfringens is classified into five toxinotypes (A-E). Some strains produce an enterotoxin (CPE), encoded by the cpe gene, which causes diarrhea in humans and some animals. C. perfringens strains that had been previously isolated and been kept at -80°C were analyzed for the presence of toxin genes and for antimicrobial resistance: 20 from soils,20 from animal, 20 from human origin and 21 from food non related to outbreaks. According to PCR results, all strains were classified as C. perfringens type A, since only α toxin gene was detected, while cpe was detected in two strains (2.5%) isolated from food, as it has been described in other world regions. Antibiotic resistance to at least one antibiotic was detected in 44% of the strains, 41% was resistant to clindamycin, 25% to chloramphenicol, 22% to penicillin and 20% to metronidazole. Soils strains showed the highest resistance percentages to almost all antibiotics. Multiresistance (to three or more antibiotic groups) was detected in the strains from soil (40%), human origin (30%), food (14%) and animal origin (5%). The high resistance rates found may be explained by the widespread use of antimicrobials as growth promoters in plants and animals; also these resistant strains may act as reservoir of resistance genes that may be transferred between bacteria in different environments. Rev. Biol. Trop. 59 (4): 1479-1485. Epub 2011 December 01.

Clostridium perfringens es un bacilo Gram positivo, esporulado, anaerobio, ampliamente distribuido en la naturaleza, que produce cuatro toxinas principales α, β, ε y ι, las cuales permiten su clasificación en cinco toxinotipos (A-E). Algunas cepas producen una enterotoxina (CPE), codificada por el gen cpe, que causa diarrea en seres humanos y en algunos animales. La presencia de los genes de estas toxinas y la sensibilidad a los antibióticos se determinó en 81 cepas de C. perfringens previamente aisladas y que habían sido mantenidas a -80°C; 20 de suelos, 20 de origen animal, 20 de origen humano y 21 de alimentos cocidos no relacionados con brotes alimentarios. De acuerdo con los resultados de PCR, todas las cepas fueron clasificadas como C. perfringens tipo A, debido a que solo se les detectó el gen de la toxina α, mientras que el gen de la enterotoxina (cpe) se detectó en dos cepas (2.5%) aisladas de alimentos, tal como ha sido descrito en otras regiones del mundo. El 44% de las cepas fue resistente a algún antibiótico; clindamicina (41%), cloranfenicol (25%), penicilina (22%) y metronidazol (20%). En general, las cepas provenientes de suelos presentaron los mayores porcentajes de resistencia a casi todos los antibióticos. El 40% de las cepas de suelo presentó multiresistencia (a tres o más grupos de antibióticos), el 30% de las de origen humano, el 14% de las de alimentos y el 5% de las de origen animal. Las altas tasas de resistencia encontradas podrían deberse al amplio uso de antibióticos como promotores de crecimiento de plantas y animales y esas cepas resistentes podrían actuar como reservorio de genes de resistencia que pueden transferirse entre bacterias de diversos ambientes.

[Molecular characterization and antimicrobial resistance of Clostridium perfringens isolates of different origins from Costa Rica]. / Caracterización molecular y resistencia antimicrobiana de aislamientos de Clostridium perfringens de diferentes orígenes en Costa Rica.

Clostridium perfringens, a Gram positive, spore-forming anaerobe, is widely distributed in nature. Based upon their production of four major toxins alpha, beta, epsilon and iota, C. perfringens is classified into five toxinotypes (A-E). Some strains produce an enterotoxin (CPE), encoded by the cpe gene, which causes diarrhea in humans and some animals. C. perfringens strains that had been previously isolated and been kept at -80 degrees C were analyzed for the presence of toxin genes and for antimicrobial resistance: 20 from soils, 20 from animal, 20 from human origin and 21 from food non related to outbreaks. According to PCR results, all strains were classified as C. perfringens type A, since only alpha toxin gene was detected, while cpe was detected in two strains (2.5%) isolated from food, as it has been described in other world regions. Antibiotic resistance to at least one antibiotic was detected in 44% of the strains, 41% was resistant to clindamycin, 25% to chloramphenicol, 22% to penicillin and 20% to metronidazole. Soils strains showed the highest resistance percentages to almost all antibiotics. Multiresistance (to three or more antibiotic groups) was detected in the strains from soil (40%), human origin (30%), food (14%) and animal origin (5%). The high resistance rates found may be explained by the widespread use of antimicrobials as growth promoters in plants and animals; also these resistant strains may act as reservoir of resistance genes that may be transferred between bacteria in different environments.

Bacterias anaerobias como agentes etiológicos de infecciones intraabdominales en un hospital de Costa Rica / Anaerobic bacteria as etiological agents of intraabdominal infections from a Costa Rican hospital

Las infecciones intraabdominales son condiciones muy serias que representan un peligro para la vida del paciente, producidas por microflora endógena del tracto gastrointestinal. Aunque el estudio de bacterias anaerobias es importante para el tratamiento de estas infecciones, en Costa Rica y en otros países latinoamericanos, pocos laboratorios lo realizan. Objetivo: Analizar la etiología anaerobia de las infecciones intraabdominales de pacientes de un hospital de adultos en Costa Rica, durante el período de 1999 al 2007. Materiales y métodos: Se investigó la presencia de bacterias anaerobias en 231 muestras de origen intraabdominal. Estas fueron tomadas por personal médico del hospital y transportadas, en anaerobiosis, hasta el Laboratorio de Investigación en Bacteriología Anaerobia. Allí se inocularon en medios prerreducidos y se subcultivaron en anaerobiosis en agar sangre suplementado. Se seleccionaron los morfotipos coloniales anaerobios, se les realizó tinción de Gram, determinación de fluorescencia, producción de pigmento y de hemólisis. La identificación definitiva se completó con el sistema RapID 32A® (bioMérieux). Resultados y conclusiones: Se aislaron 265 cepas de bacterias anaerobias a partir de 129 muestras positivas (56%): 71% Gram positivos y 29% Gram negativos, para un promedio de 2.1 aislamientos anaerobios por muestra. Bacteroides fue el género más frecuente (22%), seguido de Eggerthella y Clostridium (16 y 15%). El grupo B. fragilis fue el más frecuente en todos los tipos de muestras intraabdominales analizadas. Debido a que el conocimiento de los agentes etiológicos involucrados contribuye al éxito terapéutico en las infecciones intraabdominales, el estudio por bacterias anaerobias es recomendable no solo en los hospitales costarricenses, sino también en la región latinoamericana.

Clostridium difficile in adult patients with nosocomial diarrhea in a Costa Rican hospital.

Stool samples from 104 adult patients with nosocomial antibiotic-associated diarrhea were analyzed for Clostridium difficile by cultivation, toxin A inmunoenzymatic detection, and toxin B cytotoxic detection. The isolates were additionally screened for the toxin genes by polymerase chain reaction. C. difficile was isolated from 26 samples, and the toxins were directly detected in another 5 samples. Toxin A and B genes were detected in all toxigenic bacterial isolates. The detection rate of 30% indicates that C. difficile is a major etiologic agent of nosocomial diarrhea in Costa Rica.