Molecular epidemiology and antimicrobial resistance of Clostridium difficile in a national geriatric hospital in Costa Rica

The epidemiology of Clostridium difficile infections (CDI) is changing rapidly worldwide; knowledge on the genotypes of C. difficile circulating in specialized geriatric hospitals and their resistance to antibiotics is scarce or non-existent. Prospective study of the molecular epidemiology of CDI, conducted in a national geriatric hospital in Costa Rica for a period of 11 months. The study patients exhibited a diverse range of comorbidities, but none were associated with CDI. Polyclonality, including three new ribotypes, and a high level of resistance to antibiotics were determined by analysing the 32 isolates obtained in these cases. Despite the diversity in strains observed, the most frequent types were NAP6/RT002 and NAP2/RT001. NAP9/RT017 was associated with community acquisition. Nineteen types of antimicrobials were used before the onset of diarrhoea in the patients; no particular genotype was associated with the onset of infection or severity. Based on the abundance of strain types observed and their resistance to antibiotics in this geriatric hospital, these results contribute to a better overall understanding of the epidemiology of CDI worldwide, and to surveillance programmes targeting geriatric populations.