对氟喹诺酮类高水平耐药的艰难梭菌在西班牙出现

David

Clinical Infectious Diseases 2008;47:000–000
© 2008 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2008/4706-00XX$15.00
DOI: 10.1086/591201
BRIEF REPORT
High Levels of Resistance to Fluoroquinolones among Clostridium difficile Isolates in a Spanish Hospital
对氟喹诺酮类高水平耐药的艰难梭菌在西班牙出现
Mar Sánchez-Somolinos,
Luis Alcalá,
Teresa Peláez,
Mercedes Marín,
Adoración Martín,
Pilar Catalán, and
Emilio Bouza

Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain

Received 10 February 2008; accepted 26 May 2008; electronically published 4 August 2008.

Reprints or correspondence: Dr. Mar Sánchez-Somolinos, Servicio de Microbiología, Hospital General Universitario Gregorio Marañón, Avda. Dr. Esquerdo 46, 28007 Madrid, Spain (msanchezs35@yahoo.es).
The appearance of Clostridium difficile NAP1/027 (the epidemic strain) has been blamed for an increase in the incidence and severity of C. difficile infection. Some authors consider quinolone resistance to be a good marker of the epidemic strain. We performed a prospective study to assess C. difficile infection at our institution in Madrid, Spain (Hospital General Universitario Gregorio Marañón, Universidad Complutense). The incidence of C. difficile infection remains stable in our institution, and the epidemic strain has not yet become a problem. However, resistance to quinolones is frequent for several other ribotypes and, therefore, is a poor marker for the NAP1/027 strain.

The incidence and severity of Clostridium difficile–associated diarrhea have been increasing in recent years [1, 2], mainly in hospitals in Canada and the United States, because of the appearance and spread of a characteristic toxin-hyperproducing strain, NAP1/027 [3–5]. Morbidity and mortality resulting from C. difficile–associated diarrhea caused by this epidemic strain are higher than they were in the 1990s, and the disease may even be acquired in the community by previously healthy people, with severe consequences [6]. The ribotype 027 strain is resistant to fluoroquinolones, and some authors consider quinolone resistance to be a good marker of its presence [7]. This strain has been reported in Europe and has caused outbreaks of C. difficile–associated diarrhea in the United Kingdom, The Netherlands, Belgium, Ireland, Germany, and France [8]. Because the presence of the ribotype 027 strain has not yet been reported in Spain, we studied the incidence of C. difficile–associated diarrhea in our institution (Hospital General Universitario Gregorio Marañón, Universidad Complutense; Madrid, Spain) during the past 7 years to assess the clinical features and spectrum of the disease in our hospital and to question the value of quinolone resistance as a surrogate marker for the epidemic strain.