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However, the influence of antibiotics on sporulation is unclear. The objective of our study was to evaluate the impact of ciprofloxacin, metronidazole, piperacillin\/tazobactam, tigecycline, and vancomycin on <jats:italic>C. difficile<\/jats:italic> sporulation <jats:italic>in vitro<\/jats:italic>.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>The reference strains ATCC 9689, 630, VPI 10463, and seven other clinical isolates of <jats:italic>C. difficile<\/jats:italic> were used, including three epidemic NAP1\/027 isolates. Minimum inhibitory concentrations (MIC) were determined and sporulation was assessed after growth in the absence or presence of \u22640.5x MIC concentrations of each antibiotic.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>All strains were sensitive to the antibiotics tested, except ribotype 027 isolates that were resistant to ciprofloxacin (MIC\u2009=\u2009128\u00a0mg\/L). Metronidazole and vancomycin generally did not significantly affect spore production in <jats:italic>C. difficile<\/jats:italic>, although vancomycin slightly affected sporulation of a few isolates. Ciprofloxacin inhibited sporulation of ribotype 027 isolates mainly. Interestingly, sub-MIC concentrations of piperacillin\/tazobactam reduced spore formation in several isolates. However, the most striking observation was made with tigecycline, with an important reduction of spore formation in most isolates.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>The capacity of <jats:italic>C. difficile<\/jats:italic> to sporulate can be significantly affected by certain antibiotics. The reduced sporulation observed with tigecycline and piperacillin\/tazobactam might explain why these antibiotics are generally associated with lower risk of <jats:italic>C. difficile<\/jats:italic> infections. In addition, the inhibition of sporulation might partly explain the apparent efficacy of tigecycline for treatment of patients with recurrent infection.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/1471-2334-14-29","type":"journal-article","created":{"date-parts":[[2014,1,15]],"date-time":"2014-01-15T06:02:07Z","timestamp":1389765727000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":48,"title":["Prevention of Clostridium difficilespore formation by sub-inhibitory concentrations of tigecycline and piperacillin\/tazobactam"],"prefix":"10.1186","volume":"14","author":[{"given":"Julian R","family":"Garneau","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis","family":"Valiquette","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis-Charles","family":"Fortier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2014,1,15]]},"reference":[{"key":"2974_CR1","doi-asserted-by":"publisher","first-page":"2442","DOI":"10.1056\/NEJMoa051639","volume":"353","author":"V Loo","year":"2005","unstructured":"Loo V, Poirier L, Miller M, Oughton M, Libman M, Michaud S, Bourgault A, Nguyen T, Frenette C, Kelly M, Vibien A, Brassard P, Fenn S, Dewar K, Hudson T, Horn R, Rene P, Monczak Y, Dascal A: A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. 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