Detection of cross-infection associated to a Brazilian PCR-ribotype of Clostridium difficile in a university hospital in Rio de Janeiro, Brazil

Abstract

Clostridium difficile is an important nosocomial enteric pathogen and is the etiological agent of pseudomembranous colites. Recently, the rates of C. difficile infection (CDI) have increased worldwide, but in Brazil few data about this situation and the incidence of clonal types of C. difficile exist. This study aimed to isolate and characterize C. difficile strains from samples obtained of a university hospital (HUCFF) in Rio de Janeiro city, Brazil. CDI was identified by ELISA in 27.1% of HUCFF-in-patients enrolled in the study, and the bacterium was recovered from eight of these fecal samples. All strains, except one, presented tcdA and tcdB genes and presented neither the cdtA and cdtB genes nor any significant deletions in the tcdC gene. All strains were sensitive to metronidazole, vancomycin and moxifloxacin, and resistant to clindamycin, ciprofloxacin and levofloxacin. PCR-ribotyping and PFGE revealed four different clonal types among the isolates. The Brazilian PCR-ribotype 133 accounted for 50% of strains isolated, and PCR-ribotype 233 strains were obtained from 25% of the in-patients. The prevalence and resurgence of the Brazilian PCR-ribotype 133 among the hospitalized patients of HUCFF was established, and cross-infection of different patients associated to the same PCR-ribotypes was detected. Our results emphasize the importance of the diagnosis and control of CDI in order to prevent the emergence of specific clones that can lead to C. difficile-associated outbreaks in Brazilian hospitals.

INCIDENCE OF DIARRHEA BY Clostridium difficile IN HEMATOLOGIC PATIENTS AND HEMATOPOIETIC STEM CELL TRANSPLANTATION PATIENTS: RISK FACTORS FOR SEVERE FORMS AND DEATH

“…The literature shows that, until the moment, there is a lack of association of resistance to metronidazole with non-response or relapse 5,6,18,19,22,26 . In Brazil, two studies that evaluated C. difficile susceptibility to metronidazole showed that all strains were susceptible to metronidazole and did not identified ribotype 027 in the country 8,9 . In the present study, it was not possible to evaluate the impact of sensitivity of C. difficile isolates on therapeutic response.…”

Padronização de um modelo de infecção por Clostridium difficile em hamsters sírios Mesocricetus auratus

“…Considerando um patógeno emergente, Clostridium diffi cile é responsável pela maioria dos casos de diarreia nosocomial e colite pseudomembranosa em seres humanos (BALASSIANO et al, 2011). Em animais, a infecção por C. diffi cile (ICD) foi recentemente confi rmada no Brasil em potros, cães e descrita em uma jaguatirica criada em cativeiro (SILVA et al, 2013a;SILVA et al, 2013b;SILVA et al, 2013c).…”

Clostridium difficile infection among immunocompromised patients in Rio de Janeiro, Brazil and detection of moxifloxacin resistance in a ribotype 014 strain

“…Clostridium difficile is a Gram-positive spore forming anaerobic bacterium. C. difficile infection (CDI) is highly prevalent in hospitals and is the most common cause of nosocomial diarrhea in adults, mainly in elderly and immunocompromised patients [1,2]. CDI cases in solid organ transplant recipients, hematopoietic stem cell or bone marrow transplant recipients and HIV-seropositive individuals are reported to be higher in units caring for these patients [3].…”