High levels of resistance to fluoroquinolones among Clostridium difficile isolates in a Spanish hospital.

The appearance of Clostridium difficile NAP1/027 (the epidemic strain) has been blamed for an increase in the incidence and severity of C. difficile infection. Some authors consider quinolone resistance to be a good marker of the epidemic strain. We performed a prospective study to assess C. difficile infection at our institution in Madrid, Spain (Hospital General Universitario Gregorio Marañón, Universidad Complutense). The incidence of C. difficile infection remains stable in our institution, and the epidemic strain has not yet become a problem. However, resistance to quinolones is frequent for several other ribotypes and, therefore, is a poor marker for the NAP1/027 strain. The incidence and severity of Clostridium difficile–associated diarrhea have been increasing in recent years [1, 2], mainly in hospitals in Canada and the United States, because of the appearance and spread of a characteristic toxin-hyperproducing strain, NAP1/027 [3–5]. Morbidity and mortality resulting from C. difficile–associated diarrhea caused by this epidemic strain are higher than they were in the 1990s, and the disease may even be acquired in the community by previously healthy people, with severe consequences [6]. The ribotype 027 strain is resistant to fluoroquinolones, and some authors consider quinolone resistance to be a good marker of its presence [7]. This strain has been reported in Europe and has caused outbreaks of C. difficile–associated diarrhea in the United Kingdom, The Netherlands, Belgium, Ireland, Germany, and France [8]. Because the presence of the ribotype 027 strain has not yet been reported in Spain, we studied the incidence of C. difficile–associated diarrhea in our institution (Hospital General Univ-