Predominance and high antibiotic resistance of the emerging Clostridium difficile genotypes NAP_CR1 and NAP9 in a Costa Rican hospital over a 2-year period without outbreaks

Figures & data

Table 1 Antibiotic resistances of various Clostridium difficile genotypes recovered between October 2010 and August 2012 at a hospital without a history of outbreaks during the period under study

		Resistance (% isolates)
Genotype	Number of isolates(%)	Clindamycin	Ciprofloxacin	Moxifloxacin	Rifampicin	Metronidazole	Vancomycin
NAPCR1/012	18 (26%)	100	100	100	100	0	0
NAP9/017	14 (21%)	100	100	100	100	0	0
NAP2, NAP4, NAP6	14 (21%)	93	100	7	0	0	0
NAP10, NAP11	4 (6%)	75	100	0	0	0	0
New genotypes	8 (12%)	88	100	12	8	0	0
No NAP designation^a	3 (4%)	25	100	25	25	0	0
Non-toxigenic	7 (10%)	71	100	0	0	0	0

Includes SmaI patterns 100, 196 and 178.

Table 2 MICs and resistances of 68 isolates of Clostridium difficile recovered between October 2010 and August 2012 from a Costa Rican hospital without a history of outbreaks during the period under study

Antibiotic	MIC range (μg/mL)	MIC50 (μg/mL)	MIC90 (μg/mL)	Resistance (% isolates)
Clindamycin	1.5–>256	256	256	88
Ciprofloxacin	>32	>32	>32	100
Moxifloxacin	0.75–>32	>32	>32	50
Rifampicin	<0.002–>32	>32	>32	50
Metronidazole	0.064–1.5	0.4	1	0
Vancomycin	0.38–4.0	1	2	0

Abbreviation: minimum inhibitory concentration, MIC.

Figure 1 Epidemic curves for the stool samples that were positive for C. difficile (CD) toxins and were collected in a major hospital in Costa Rica from 2010 to 2012. The cases were diagnosed based on clinical evidence and toxin detection.

Figure 2 Pulse field gel electrophoresis results of representative C. difficile genotypes that were isolated between October 2010 and August 2012 from a hospital without a history of outbreaks during the period under study.