{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T10:38:31Z","timestamp":1791110311921,"version":"4.1.0"},"reference-count":37,"publisher":"American Society for Microbiology","issue":"8","license":[{"start":{"date-parts":[[2001,8,1]],"date-time":"2001-08-01T00:00:00Z","timestamp":996624000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Antimicrob Agents Chemother"],"published-print":{"date-parts":[[2001,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>\n            <jats:italic>Clostridium difficile<\/jats:italic>\n            is the etiological agent of antibiotic-associated colitis and the most common cause of hospital-acquired infectious diarrhea. Fluoroquinolones such as ciprofloxacin are associated with lower risks of\n            <jats:italic>C. difficile<\/jats:italic>\n            -associated diarrhea. In this study, we have analyzed 72\n            <jats:italic>C. difficile<\/jats:italic>\n            isolates obtained from patients with different clinical courses of disease, such as toxic megacolon and relapses; the hospital environment; public places; and horses. They were investigated for their susceptibilities to moxifloxacin (MXF), metronidazole (MEO), and vancomycin (VAN). Mutants highly resistant to fluoroquinolones were selected in vitro by stepwise exposure to increasing concentrations of MXF. The resulting mutants were analyzed for the presence of mutations in the quinolone resistance-determining regions of DNA gyrase (\n            <jats:italic>gyrA<\/jats:italic>\n            ), the production of toxins A and B, and the epidemiological relationship of these isolates. These factors were also investigated using PCR-based methods. All strains tested were susceptible to MEO and VAN. Twenty-six percent of the clinical isolates (19 of 72) were highly resistant to MXF (MIC \u2265 16 \u03bcg\/ml). Fourteen of these 19 strains contained nucleotide changes resulting in amino acid substitutions at position 83 in the\n            <jats:italic>gyrA<\/jats:italic>\n            protein. Resistant strains selected in vitro did not contain mutations at that position. These findings indicate that resistance to MXF in a majority of cases may be due to amino acid substitution in the\n            <jats:italic>gyrA<\/jats:italic>\n            gene.\n          <\/jats:p>","DOI":"10.1128\/aac.45.8.2348-2353.2001","type":"journal-article","created":{"date-parts":[[2002,7,27]],"date-time":"2002-07-27T10:06:42Z","timestamp":1027764402000},"page":"2348-2353","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":70,"title":["Resistance to Moxifloxacin in Toxigenic\n            <i>Clostridium difficile<\/i>\n            Isolates Is Associated with Mutations in\n            <i>gyrA<\/i>"],"prefix":"10.1128","volume":"45","author":[{"given":"Grit","family":"Ackermann","sequence":"first","affiliation":[{"name":"<!--label omitted: 1-->Department of Internal Medicine, Division of Infectious Diseases, University of California-Davis, Medical Center, Sacramento, California,1 and"},{"name":"<!--label omitted: 2-->Institute for Medical Microbiology and Epidemiology of Infectious Diseases, University of Leipzig, 04103 Leipzig,2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yajarayma J.","family":"Tang","sequence":"additional","affiliation":[{"name":"<!--label omitted: 1-->Department of Internal Medicine, Division of Infectious Diseases, University of California-Davis, Medical Center, Sacramento, California,1 and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Kueper","sequence":"additional","affiliation":[{"name":"<!--label omitted: 3-->Merlin Diagnostika mbH, 53332 Bornheim-Hersel,3 and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Heisig","sequence":"additional","affiliation":[{"name":"<!--label omitted: 4-->Department of Pharmaceutical Biology, Institute of Pharmacy, University of Hamburg, 20146 Hamburg,4 Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arne C.","family":"Rodloff","sequence":"additional","affiliation":[{"name":"<!--label omitted: 2-->Institute for Medical Microbiology and Epidemiology of Infectious Diseases, University of Leipzig, 04103 Leipzig,2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr.","given":"Joseph","family":"Silva","sequence":"additional","affiliation":[{"name":"<!--label omitted: 1-->Department of Internal Medicine, Division of Infectious Diseases, University of California-Davis, Medical Center, Sacramento, California,1 and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart H.","family":"Cohen","sequence":"additional","affiliation":[{"name":"<!--label omitted: 1-->Department of Internal Medicine, Division of Infectious Diseases, University of California-Davis, Medical Center, Sacramento, California,1 and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1007\/s100960050465","article-title":"Comparative activity of moxifloxacin in vitro against obligately anaerobic bacteria.","volume":"19","author":"Ackermann G.","year":"2000","unstructured":"Ackermann G. Schaumann R. Pless B. Claros M. C. Goldstein E. J. C. Rodloff A. C. Comparative activity of moxifloxacin in vitro against obligately anaerobic bacteria. Eur. J. Clin. Microbiol. Infect. Dis. 19 2000 228 232","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"e_1_3_2_3_2","doi-asserted-by":"crossref","first-page":"S11","DOI":"10.1093\/clinids\/6.Supplement_1.S11","article-title":"Biochemical characterisation and biological action of two toxins (D-1 and D-2) from Clostridium difficile.","volume":"6","author":"Banno Y.","year":"1984","unstructured":"Banno Y. Kobayashi T. Kono H. Watanabe K. Veno K. Nozawa Y. Biochemical characterisation and biological action of two toxins (D-1 and D-2) from Clostridium difficile. Rev. Infect. Dis. 6 1984 S11 S20","journal-title":"Rev. Infect. 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Agents Chemother."},{"key":"e_1_3_2_27_2","doi-asserted-by":"crossref","first-page":"2470","DOI":"10.1128\/IAI.68.5.2470-2474.2000","article-title":"pH-induced conformational changes in Clostridium difficile toxin B.","volume":"68","author":"Qa'Dan M.","year":"2000","unstructured":"Qa'Dan M. Spyres L. M. Ballard J. D. pH-induced conformational changes in Clostridium difficile toxin B. Infect. Immun. 68 2000 2470 2474","journal-title":"Infect. Immun."},{"key":"e_1_3_2_28_2","doi-asserted-by":"crossref","first-page":"343","DOI":"10.2307\/30141229","article-title":"Vancomycin-resistant enterococci in stool specimens submitted for Clostridium difficile cytotoxin assay.","volume":"18","author":"Rafferty M. E.","year":"1997","unstructured":"Rafferty M. E. McCormick M. I. Bopp L. H. Baltch A. L. George M. Smith R. P. Rheal C. Ritz W. Schoonmaker D. Vancomycin-resistant enterococci in stool specimens submitted for Clostridium difficile cytotoxin assay. Infect. Control Hosp. 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