To investigate the relationship between Clostridium (Clostridioides) difficile strain characteristics and C. difficile infection (CDI) outcome. Between October and December 2017, 16 hospitals collected epidemiological data according to the European Centre for Disease Prevention and Control (ECDC) surveillance protocol for CDI. C. difficile isolates were characterized by ribotyping, toxin genes detection and antibiotic susceptibility testing to metronidazole, vancomycin and moxifloxacin. The overall mean CDI incidence density was 4.5 [95% CI 3.6–5.3] cases per 10,000 patient-days. From the 433 CDI cases, 330 (76.2%) were healthcare-associated, 52 (12.0%) cases were community-associated or of unknown origin and 51 (11.8%) CDI cases recurrent; a complicated course of CDI was reported in 65 cases (15.0%). Eighty-eight (20.3%) of patients died and 59 of them within 30 days after the CDI diagnosis. From the 379 C. difficile isolates, the most prevalent PCR ribotypes were 001 (n = 127, 33.5%) and 176 (n = 44, 11.6%). A total of 186 (49.1%) isolates showed a reduced susceptibility to moxifloxacin (> 4 mg/L) and 96.4% of them had Thr82Ile in the GyrA. Nineteen isolates revealed reduced susceptibility to metronidazole and two isolates to vancomycin (> 2 mg/L). A fatal outcome was associated with a reduced susceptibility to moxifloxacin, the advanced age of the patients and a complicated course of CDI (p<0.05). No association between ribotype, binary toxin and a reduced susceptibility to moxifloxacin and complicated course or recurrent CDI was found. A reduced susceptibility to moxifloxacin, in causative C. difficile strains was associated with fatal outcome of the patients, therefore it is an important marker in surveillance of CDI.

中文翻译：

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致病艰难梭菌菌株对莫西沙星敏感性降低与患者临床结果的关系。

探讨艰难梭菌 (Clostridioides) 菌株特征与艰难梭菌感染 (CDI) 结果之间的关系。2017年10月至12月期间，16家医院根据欧洲疾病预防和控制中心（ECDC）的CDI监测方案收集了流行病学数据。通过核糖分型、毒素基因检测和对甲硝唑、万古霉素和莫西沙星的抗生素敏感性测试来表征艰难梭菌分离株。总体平均 CDI 发生密度为每 10,000 个患者日 4.5 例 [95% CI 3.6–5.3] 例。在 433 例 CDI 病例中，330 例（76.2%）与医疗相关，52 例（12.0%）与社区相关或来源不明，51 例（11.8%）CDI 复发病例；65 例 (15.0%) 报告了复杂的 CDI 病程。88 名患者 (20.3%) 死亡，其中 59 人在 CDI 诊断后 30 天内死亡。在 379 个艰难梭菌分离株中，最常见的 PCR 核糖型是 001（n = 127，33.5%）和 176（n = 44，11.6%）。总共 186 个分离株 (49.1%) 对莫西沙星 (> 4 mg/L) 的敏感性降低，其中 96.4% 在 GyrA 中具有 Thr82Ile。19 个分离株对甲硝唑的敏感性降低，2 个分离株对万古霉素 (> 2 mg/L) 的敏感性降低。致命结果与莫西沙星敏感性降低、患者高龄和复杂的 CDI 病程相关（p<0.05）。未发现核糖体型、二元毒素与莫西沙星敏感性降低和复杂病程或复发性 CDI 之间存在关联。艰难梭菌致病菌株对莫西沙星的敏感性降低与患者的致命结果相关，因此它是 CDI 监测的重要标志物。