Clostridioides difficile is an important health care-associated pathogen. The aim of this study was to analyze the antibiotic susceptibility of C. difficile isolates from feces of patients from 13 hospitals in Silesia, Poland. The incidence of CDI per 100.000 people in Silesia in 2018–2019 was higher than the average in Poland (39.3–38.7 vs. 30.2–29.5, respectively). The incidence doubled from 26.4 in 2020 to 55.1 in 2021. Two hundred and thirty stool samples tested positive for GDH (glutamate dehydrogenase) and toxins were cultured anaerobically for C. difficile. The isolates were characterized, typed, and tested for susceptibility to 11 antibiotics by E-test (EUCAST, 2021). The genes of toxins A/B and binary were detected by mPCR. Of 215 isolates, 166 (77.2%) were classified as RT 027 and 6 (2.8%) as related RT 176. Resistance to ciprofloxacin (96.7%), moxifloxacin (79.1%), imipenem (78.1%), penicillin (67%), and rifampicin (40.5%) was found. The ermB gene was detected in 79 (36.7%) strains. Multidrug resistance (MDR) was confirmed in 50 (23.3%) strains of RT 027 (94%). We concluded that a high prevalence of MDR among hypervirulent RT 027/176 C. difficile was found in the Silesian region of Poland, emphasizing the need to enhance regional infection control on CDI and antibiotic stewardships.

Objective: The aim of this study was Clostridioides difficile outbreak investigation due to the emergence of rifampicin resistant ribotype 027 (RT 027) fecal isolates from patients of Polish tertiary care hospital between X. 2017 and II. 2018 using multilocus variable tandem repeat analysis (MLVA). Materials and Methods: Twenty-nine C. difficile fecal isolates from patients of tertiary care hospital in Southern Poland were ribotyped and analyzed by MLVA. Multiplex PCR (mPCR) for genes encoding GDH (gluD), toxins A (tcdA)/ B (tcdB), 16S rDNA and binary toxin genes (ctdA and ctdB) was performed. The antibiotic susceptibility profile was determined by E-test. Results: The A, B and binary toxins encoding genes were detected in all 29 C. difficile strains which were sensitive to metronidazole, vancomycin and were resistant to erythromycin, clindamycin, and moxifloxacin; resistance to imipenem demonstrated 97%, to rifampicin – 45% isolates. C. difficile strains could be grouped by MLVA into 5 distinct clusters, and the largest cluster II contains 16 strains. The comparison of rifampicin GM MIC of cluster II (n=16 strains) with all others (n=13) showed that strains from clusters I, III, IV and V possessed significantly (p < 0.005) higher GM MIC and were more resistant to rifampicin. Conclusion: MLVA analysis proved transmission and recognized outbreak due to multidrug-resistant RT 027 C. difficile among patients of tertiary care hospital in Southern Poland. The reason for this is probably the widespread occurrence of spores in the hospital environment, which includes, among others, neglect of hygienic procedures and epidemic supervision. High resistance to imipenem (97%) and to rifampicin (45%) among C. difficile RT 027 Silesian isolates is threatening and requires further studies to elucidate this phenomenon.

This paper attempts to determine the role of the hospital environment in the spread of Clostridioides/Clostridium (C.) difficile infections based on a review of studies published in the medical literature and in the light of the authors’ own experiences. Clostridioides/ Clostridium difficile...

Background: Recent studies have shown that up to 25% of sepsis cases originate in the urinary tract. Urosepsis can be as-sociated with cystitis, lower urinary tract infections (UTIs), and upper UTIs and is most commonly caused by gram-negative bacteria. This retrospective study from a urology center in southern Poland, was conducted be-tween 2017 and 2020 and aimed to investigate the causes, microbiology laboratory findings, and management in 138 patients with UTIs and urosepsis. Material/Methods: Records of patients with UTIs with urosepsis admitted to the Urology Department of the hospital in Silesia, Poland, between 2017 and 2020 were analyzed retrospectively, and clinical and laboratory data were evaluated. Results: The 138 included patients were admitted to the hospital between 2017 and 2020. The median age of patients was 67 (20-94) years, and 59.9% (82/137) were men. The most common reasons for admission to the Urology Department were hydronephrosis due to dysfunction of urinary drainage in 36.5% (50/137) of patients and hydronephrosis due to urolithiasis in 22.6% (31/137) of patients. The main etiological agents responsible for the development of urosepsis were strains of Enterobacteriaceae in 85% of patients, of which 41.4% (48/116) produced extended-spectrum beta-lactamases (ESBL), accounting for 35.0% (48/137) of patients with urosep-sis. In 83.3% (80/96) of patients, the pathogen cultured from the urine was identical to that cultured from the blood. Conclusions: The identification of an increasing prevalence of urosepsis associated with ESBL-producing gram-negative rods from this single-center study highlights the importance of infection monitoring, rapid diagnosis, and multidis-ciplinary patient management.

Introduction: Toxigenic strains of Clostridioides difficile are the leading cause of healthcare-associated bacterial infections in Poland. In the Silesian Voivodeship, with 4.5 million inhabitants, the incidence of C. difficile infection (CDI) in 2023 reached 65.1/100,000, slightly down from 70.0/100,000 in 2022. This study aimed to investigate the occurrence of toxigenic C. difficile ribotypes in hospitalized patients in Silesia.Materials and methods: A total of 130 stool samples from patients with confirmed antibiotic-associated diarrhea were tested. Multiplex PCR detected genes for GDH, toxins A/B, binary toxin CDT, and 16S rDNA. Ribotyping was performed by capillary PCR, and antibiotic susceptibility was tested with ETEST for 10 antibiotics.Results: Multiplex PCR confirmed the presence of all toxins (A⁺B⁺CDT⁺) in 97 isolates. Six strains (6%) represented ribotype 955 (RT955), first reported in Poland in 2023. RT027 remained dominant (60%, n = 78). All isolates were susceptible to vancomycin, while 4% (5/130) showed metronidazole resistance.Conclusion: RT027 remains prevalent among CDI cases in Silesia. The emergence of RT955, closely related to a UK epidemic strain, suggests a possible shared origin and epidemiological link.

Wstęp: W celu oceny ogniska zakażenia Clostridioides difficile (Clostridioides difficile infection – CDI) w okresie od grudnia 2018 r. do lutego 2019 r. na oddziale chorób wewnętrznych szpitala powiatowego na Śląsku objęto badaniem materiały kliniczne od 5 pacjentów (6 stolców).Materiał i metody: Zidentyfikowano izolaty C. difficile, geny kodujące dehydrogenazę glutaminianową (GDH) – gluD, toksyny A/B – tcdA/tcdB oraz geny cdtA/cdtB kodujące toksynę binarną, ermB wykryto za pomocą mPCR, a antybiotykooporność za pomocą E-testów.Wyniki: Wśród pacjentów dominowały kobiety (4/5). Wszystkie szczepy C. difficile (6) należały do hiperepidemicznego rybotypu 027, we wszystkich szczepach wykazano obecność badanych genów oraz wykryto oporność na: moksyfloksacynę, erytromycynę, klindamycynę, ryfampicynę, imipenem i chloramfenikol.Wnioski: Uzyskane wyniki świadczą o szerzeniu się na oddziale hiperepidemicznego klonu C. difficile o rybotypie 027.