Characteristics of Clostridioides difficile isolates circulating in the Slovak hospitals

Clostridioides difficile is a frequent cause of hospital-acquired diarrhea associated with antibiotics. Hypervirulent strains of Clostridioides difficile are associated with a severe course of Clostridioides difficile infection and a higher mortality. We have confirmed 322 non-duplicate Clostridioides difficile isolates in stool samples of patients hospitalized in three Slovak hospitals providing primary health care between January and December 2021 and determined genes encoding toxins, ribotypes and susceptibility to antimicrobials. 93.7% of them were toxigenic and co-occurrence of genes tcdA, tcdB, cdtA, cdtB , which encode toxins, was detected in 71.4% isolates. Nosocomially associated ribotypes 176, 001, and 027 were confirmed in 61.1%, 10.2%, and 5.2% of isolates, respectively, and found to be the most frequent. Although ribotype 176 predominated in all three hospitals, the highest incidence was recorded in Košice (73.5%). Results of antimicrobial susceptibility testing revealed 65.8% resistance rate for rifampicin, 5.2% for vancomycin, 1.5% for metronidazole, 1.2% for teicoplanin and 0.6% for doxycycline. The correlation of frequent ribotypes and results of antimicrobial susceptibility testing points to the predominance of rifampicin resistance in isolates belonging to ribotypes 176 and 027. The above results reflect the problematic situation in our hospitals during the COVID-19 pandemic, that was related to the misuse of broad-spectrum antibiotics and impossibility to follow epidemiological measures to prevent the spread of hypervilulent isolates.