Circulation of Highly Drug-Resistant Clostridium difficile Ribotypes 027 and 001 in Two Tertiary-Care Hospitals in Mexico

Adrian Adrian Martinez-Melendez, Laura Tijerina-Rodrıguez, Rayo Morfin-Otero, Adrian Camacho-Ortiz, Licet Villarreal-Trevino, Hugo Sanchez-Alanıs, Eduardo Rodrıguez-Noriega, Simon Baines, Samantha Flores-Trevino, Hector Jesus Maldonado-Garza, Elvira Garza-Gonzalez

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OBJECTIVE: To assess drug susceptibility and characterize Clostridium difficile ribotypes in isolates from two tertiary-care hospitals in Mexico.

METHODS: Isolates were evaluated for genotyping, antimicrobial susceptibility testing and detection of mutations associated with drug resistance. PCR ribotyping was performed using a combination of gel-based and capillary electrophoresis-based approaches.

RESULTS: MIC50 and MIC90 were ≥128 mg/L for ciprofloxacin, erythromycin, clindamycin, and rifampicin. There was no reduced susceptibility to metronidazole or tetracycline; however, reduced susceptibility to vancomycin (≥4 mg/L) and fidaxomicin (≥2 mg/L) was detected in 50 (40.3%) and 4 (3.2%) isolates, respectively. Furthermore, the rpoB Arg505Lys mutation was more frequently detected in isolates with high minimum inhibitory concentration (MIC) to rifampicin (≥32 mg/L) (OR = 52.5; 95% CI = 5.17-532.6; p < 0.000). Of the 124 C. difficile isolates recovered, 84 (66.7%) were of ribotype 027, 18 (14.5%) of ribotype 001, and the remainder were other ribotypes (353, 255, 220, 208, 176, 106, 076, 020, 019, 017, 014, 012, 003, and 002).

CONCLUSION: Ribotypes 027 and 001 were the most frequent C. difficile isolates recovered in this study, and demonstrated higher MICs. Furthermore, we found four isolates with reduced susceptibility to fidaxomicin, raising a concern since this drug is currently unavailable in Mexican Hospitals.

Original languageEnglish
Pages (from-to)386-392
Number of pages7
JournalMicrobial Drug Resistance
Issue number4
Early online date27 Feb 2018
Publication statusPublished - 1 May 2018


  • Clostridium difficile
  • drug resistance
  • fidaxomicin
  • ribotype 001
  • ribotypes


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