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Antimicrobial Agents and Chemotherapy, November 2002, p. 3418-3421, Vol. 46, No. 11
0066-4804/02/$04.00+0     DOI: 10.1128/AAC.46.11.3418-3421.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.

gyrA and gyrB Mutations Are Implicated in Cross-Resistance to Ciprofloxacin and Moxifloxacin in Clostridium difficile

Laboratoire de Bactériologie, Centre Hospitalo-Universitaire Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Université Paris VI, Paris, France

Received 12 April 2002/ Returned for modification 18 July 2002/ Accepted 13 August 2002

A total of 198 nonrepetitive clinical strains of Clostridium difficile isolated from different French hospitals in 1991 (n = 100) and 1997 (n = 98) were screened for decreased susceptibility to fluoroquinolones by plating onto Wilkins-Chalgren agar containing 16 µg of ciprofloxacin per ml. The frequency of decreased susceptibility was 7% (14 of 198) and was identical for the years 1991 and 1997. Serogroups C, H, D, A9, and K accounted for five, four, two, one, and one of the resistant strains, respectively, one strain being nontypeable. Arbitrarily primed PCR typing showed that all resistant strains had unique patterns except two serotype C strains, which could not be clearly distinguished. All isolates with decreased susceptibility carried a mutation either in gyrA (eight mutations, amino acid changes Asp71Val in one, Thr82Ile in six, and Ala118Thr in one) or in gyrB (six mutations, amino acid changes Asp426Asn in five and Arg447Leu in one). These changes are similar to those already described in other species except for Asp71Val, which is novel, and Ala118Thr, which is exceptional. Attempts to detect the topoisomerase IV parC gene by PCR amplification with universal parC primers or DNA-DNA hybridization under low-stringency conditions were unsuccessful. The susceptibilities of all resistant strains to ciprofloxacin and ethidium bromide were not affected by the addition of reserpine at 20 µg/ml. In conclusion, decreased susceptibility to fluoroquinolones in C. difficile is rare in France and is associated with the occurrence of a gyrA or gyrB mutation.

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