A retrospective study of the epidemiology of Clostridium difficile infection at a University Hospital in Japan: genotypic features of the isolates and clinical characteristics of the patients

Iwashima, Yasuhito; Nakamura, Atsushi; Kato, Haru; Kato, Hideaki; Wakimoto, Yukio; Wakiyama, Naoki; Kaji, Chiharu; Ueda, Ryuzo

doi:10.1007/s10156-010-0066-4

Cited by 39 publications

(37 citation statements)

References 22 publications

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“…[1][2][3] Unfortunately data on the incidence of C. difficile infection in Asia in particular are more limited but the available reports suggest an increasing number in countries including Singapore, Taiwan, Korea, India and Japan. [4][5][6][7][8] C. difficile is a grampositive spore-forming bacterium, producing cytotoxin (toxin A, B) and the resulting pathology can vary from being asymptomatic to pseudomembranous colitis, a condition with high morbidity.…”

Section: Introductionmentioning

confidence: 99%

Hospital-acquired Clostridium difficile infection among patients with type 2 diabetes mellitus in acute medical wards

Hassan

Rahman²,

Huda³

et al. 2013

J R Coll Physicians Edinb

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Background:Clostridum difficile (C. difficile) infection is increasingly seen among hospitalised patients with type 2 diabetes mellitus but its rate and associated risk factors are not known. We aimed to determine the rate and characteristics of hospital-acquired C. difficile infection in subjects with type 2 diabetes mellitus admitted into acute medical wards. Methods: Our prospective cross-sectional study involved 159 patients with established type 2 diabetes mellitus admitted into acute medical wards who developed a hospital-acquired C. difficile infection. Stools were tested for C. difficile toxins using a toxin A/B kit and a toxin A kit. Clinical features, laboratory findings, types of antibiotics, and use of a proton pump inhibitor were examined for their association with the infection. Results: Thirteen subjects were positive for toxin A and one for toxin B. Using univariable analysis, we found that patients with type 2 diabetes mellitus and hospitalacquired C. difficile infection were younger (mean 53.8 years, p=0.02), had diarrhoea and abdominal pain (p=0.001) but no fever. Sepsis (p=0.02) and use of a proton pump inhibitor (p=0.01) were more commonly implicated as the cause of the infection. Of the various types of antibiotics prescribed, carbapenem (28.6% vs 4.1%, p=0.01) and metronidazole (42.9% vs 19.3%, p=0.04) were significantly associated with hospitalacquired C. difficile infection. Conclusions: Patients with type 2 diabetes mellitus admitted into acute medical wards and who developed hospital-acquired C. difficile infection have distinct characteristics.

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Section: Introductionmentioning

confidence: 99%

Hospital-acquired Clostridium difficile infection among patients with type 2 diabetes mellitus in acute medical wards

Hassan

Rahman²,

Huda³

et al. 2013

J R Coll Physicians Edinb

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“…In Japan, we have reported that a specific C. difficile type strain, PCR-ribotype smz, has been dominant at numerous hospitals since the 1990s (Kato et al, 2001a(Kato et al, , 2010Sawabe et al, 2007;Iwashima et al, 2010). In addition, frequent isolation of A 2 B + C. difficile has been noted at some Japanese hospitals (Komatsu et al, 2003;Sato et al, 2004;Kato et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

“…In addition, frequent isolation of A 2 B + C. difficile has been noted at some Japanese hospitals (Komatsu et al, 2003;Sato et al, 2004;Kato et al, 2010). In the present study, we analysed C. difficile isolates collected from 15 different hospitals between 2011 and 2013 in non-outbreak settings, and from outbreaks that occurred independently in 2009 and 2010 at two hospitals in Japan.…”

Section: Introductionmentioning

confidence: 99%

Predominance of PCR-ribotypes, 018 (smz) and 369 (trf) of Clostridium difficile in Japan: a potential relationship with other global circulating strains?

Senoh

Kato

Fukuda

et al. 2015

Journal of Medical Microbiology

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Predominance of 018 (smz) and 369 (trf) resistance against gatifloxacin, moxifloxacin, erythromycin and clindamycin were observed in the PCR-ribotype 018 isolates. Interestingly, all trf isolates were toxin A-negative, toxin B-positive, but they did not correspond to PCR-ribotype 017, thus being assigned a new ribotype (PCRribotype 369). In conclusion, PCR-ribotypes 018 (smz) and 369 (trf) were identified as major circulating strains in both outbreak and non-outbreak settings in Japan. Given their epidemiological relevance, molecular investigations are warranted to clarify potential evolutionary links with related strains found elsewhere, such as PCR-ribotypes 018 and 017 from Europe and North America.

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“…Other parts of the world, including South America, appear to be spared from C. difficile infections, although the very small number of reported cases from South America may be partially due to lack of diagnostic testing (3). In the Far East, some countries, such as Japan and Korea, have recognized for some time that C. difficile is a significant cause of nosocomial infections (4,5). In the case of the region's most populous country, China, the situation is less clear.…”

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Molecular Epidemiology of Clostridium difficile Infection in a Major Chinese Hospital: an Underrecognized Problem in Asia?

et al. 2013

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Clostridium difficile infection is almost unrecognized in mainland China. We have undertaken a study in a large Chinese teaching hospital in Changsha, Hunan, China, to identify cases of C. difficile, record patient characteristics, and define the molecular epidemiology with respect to ribotype distribution and cross-infection. Between April 2009 and February 2010, we examined fecal samples from 70 hospitalized patients with diarrhea who were receiving or had received antibiotics within the previous 6 weeks. Clinical information was collected and the samples were cultured for C. difficile retrospectively. Isolates were ribotyped, and multiple-locus variable-number tandem-repeat assay (MLVA) subtyping was performed on clusters of the same ribotype. The mean age of patients from whom C. difficile was cultured was 58 years, with only 4/21 patients aged >65 years. All patients, with a single exception, had received a third-generation cephalosporin and/or a quinolone antibiotic. Twenty-one isolates of C. difficile were recovered, and seven different ribotypes were identified, the dominant types being 017 (48%), 046 (14%), and 012 (14%). We identified two clusters of cross-infection with indistinguishable isolates of ribotype 017, with evidence of spread both within and between wards. We have identified C. difficile as a possibly significant problem, with cross-infection and a distinct ribotype distribution, in a large Chinese hospital. C. difficile may be underrecognized in China, and further epidemiological studies across the country together with the introduction of routine diagnostic testing are needed to ascertain the size of this potentially significant problem.

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A retrospective study of the epidemiology of Clostridium difficile infection at a University Hospital in Japan: genotypic features of the isolates and clinical characteristics of the patients

Cited by 39 publications

References 22 publications

Hospital-acquired Clostridium difficile infection among patients with type 2 diabetes mellitus in acute medical wards

Hospital-acquired Clostridium difficile infection among patients with type 2 diabetes mellitus in acute medical wards

Predominance of PCR-ribotypes, 018 (smz) and 369 (trf) of Clostridium difficile in Japan: a potential relationship with other global circulating strains?

Molecular Epidemiology of Clostridium difficile Infection in a Major Chinese Hospital: an Underrecognized Problem in Asia?

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