TY - JOUR A2 - Vanittanakom, Nongnuch AU - Rodriguez-Palacios, Alex AU - Ilic, Sanja AU - LeJeune, Jeffrey T. PY - 2014 DA - 2014/12/14 TI -Clostridium difficilewith Moxifloxacin/Clindamycin Resistance in Vegetables in Ohio, USA, and Prevalence Meta-Analysis SP - 158601 VL - 2014 AB - We (i) determined the prevalence of Clostridium difficileand their antimicrobial resistance to six antimicrobial classes, in a variety of fresh vegetables sold in retail in Ohio, USA, and (ii) conducted cumulative meta-analysis of reported prevalence in vegetables since the 1990s. Six antimicrobial classes were tested for their relevance as risk factors for C. difficileinfections (CDIs) (clindamycin, moxifloxacin) or their clinical priority as exhaustive therapeutic options (metronidazole, vancomycin, linezolid, and tigecycline). By using an enrichment protocol we isolated C. difficilefrom three of 125 vegetable products (2.4%). All isolates were toxigenic, and originated from 4.6% of 65 vegetables cultivated above the ground ( n = 3 ; outer leaves of iceberg lettuce, green pepper, and eggplant). Root vegetables yielded no C. difficile. The C. difficileisolates belonged to two PCR ribotypes, one with an unusual antimicrobial resistance for moxifloxacin and clindamycin (lettuce and pepper; 027-like, A⁺B⁺CDT⁺; tcdC18 bp deletion); the other PCR ribotype (eggplant, A⁺B⁺CDT⁻; classic tcdC) was susceptible to all antimicrobials. Results of the cumulative weighted meta-analysis (6 studies) indicate that the prevalence of C. difficilein vegetables is 2.1% and homogeneous ( P < 0.001 ) since the first report in 1996 (2.4%). The present study is the first report of the isolation of C. difficilefrom retail vegetables in the USA. Of public health relevance, antimicrobial resistance to moxifloxacin/clindamycin (a bacterial-associated risk factor for severe CDIs) was identified on the surface of vegetables that are consumed raw. SN - 2090-3057 UR - https://doi.org/10.1155/2014/158601 DO - 10.1155/2014/158601 JF - Journal of Pathogens PB - Hindawi Publishing Corporation KW - ER -