PREVALENCE OF CLOSTRIDIUM DIFFICILE PCR RIBOTYPES IN BULGARIA, 2008-2010

Clostridium difficile is one of the most important causative agents of severe diarrhoea in hospitalised patients treated with antibiotics. Since 2008, Bulgaria participated in the Pan-European Surveillance Study investigating the prevalence of C. difficile infections (CDI) in different European countries. In the period November 2008 - March 2010, the incidence of CDI in nine participating hospitals was 7.94 per 10 000 patient admissions (0.34 per 10 000 patient-days). In total, sixty five fecal samples from patients with mild to severe enterocolitis and previous antibiotic treatment were investigated for CDI. Strains were typed and further characterized for the presence of toxins A (TcdA), B (TcdB) and binary toxins (CdtA and CdtB). Of 65 stool samples included, 15 were toxin and culture positive for C. difficile. Six of the isolates (40%) belonged to PCR ribotype 017 (TcdA(-).; TcdB(+); CdtA/B(-)), followed by 002 (n = 2 isolates) and 014 (n = 2 isolates). The remaining C. difficile isolates were typed as 012 (n = 1), 046 (n = 1), 078 ribotypes (n = 1) and 2 isolates were untypable. In conclusion, after the Pan-European surveillance study, a laboratory-based surveillance of CDI has been introduced in Bulgaria. The most prevalent C. difficile ribotype in Bulgaria was 017 (40%). All determined PCR ribotypes were found to be associated with severe CDI and a high percentage of lethal outcomes, indicating that improvements of surveillance with appropriate clinical and epidemiological criteria is warranted.