Emergence of
            <i>Clostridium difficile</i>
            NAP1 in Latin America

Quesada-Gómez, Carlos; Rodríguez, César; Gamboa-Coronado, María del Mar; Rodríguez-Cavallini, Evelyn; Du, Tim; Mulvey, Michael R.; Villalobos-Zúñiga, Manuel Antonio; Boza-Cordero, Ricardo

doi:10.1128/jcm.02196-09

Cited by 56 publications

(53 citation statements)

References 11 publications

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“…Our strain selection, which was influenced by the availability of isolates in wellcharacterized hospital collections, such as the Canadian Nosocomial Infection Surveillance Program, included an emphasis on isolates of the predominant epidemic strain (NAP1) as well as an isolate of another SDA strain (NAP7) previously reported in the literature (17,38). Our strain choices comprised the majority of SDA strain types (21,32,46,61) as well as two widely used research reference isolates (CIP107932 and VPI10463). Our testing of an extended panel of isolates, from an even wider diversity of strain types than those described here, further demonstrated that we have analyzed C. difficile representing a wide spectrum of naturally occurring genetic diversity.…”

Section: Discussionmentioning

confidence: 99%

Fourteen-Genome Comparison Identifies DNA Markers for Severe-Disease-Associated Strains of Clostridium difficile

et al. 2011

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Clostridium difficile is a common cause of infectious diarrhea in hospitalized patients. A severe and increased incidence of C. difficile infection (CDI) is associated predominantly with the NAP1 strain; however, the existence of other severe-disease-associated (SDA) strains and the extensive genetic diversity across C. difficile complicate reliable detection and diagnosis. Comparative genome analysis of 14 sequenced genomes, including those of a subset of NAP1 isolates, allowed the assessment of genetic diversity within and between strain types to identify DNA markers that are associated with severe disease. Comparative genome analysis of 14 isolates, including five publicly available strains, revealed that C. difficile has a core genome of 3.4 Mb, comprising ϳ3,000 genes. Analysis of the core genome identified candidate DNA markers that were subsequently evaluated using a multistrain panel of 177 isolates, representing more than 50 pulsovars and 8 toxinotypes. A subset of 117 isolates from the panel had associated patient data that allowed assessment of an association between the DNA markers and severe CDI. We identified 20 candidate DNA markers for species-wide detection and 10,683 single nucleotide polymorphisms (SNPs) associated with the predominant SDA strain (NAP1). A species-wide detection candidate marker, the sspA gene, was found to be the same across 177 sequenced isolates and lacked significant similarity to those of other species. Candidate SNPs in genes CD1269 and CD1265 were found to associate more closely with disease severity than currently used diagnostic markers, as they were also present in the toxin A-negative and B-positive (A-B؉) strain types. The genetic markers identified illustrate the potential of comparative genomics for the discovery of diagnostic DNA-based targets that are species specific or associated with multiple SDA strains.

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Section: Discussionmentioning

confidence: 99%

Fourteen-Genome Comparison Identifies DNA Markers for Severe-Disease-Associated Strains of Clostridium difficile

et al. 2011

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“…Isolates were recovered by placing inoculating loops of stool samples onto cefoxitincycloserine fructose agar plates (Oxoid, Ltd Basingstoke, UK), and were subsequently identified by the rapid ID32A system (BioMérieux, Marcy l'Etoile, FR) and PCR amplification of the triose phosphate isomerase gene. Isolates were typed by pulsed-field gel electrophoresis (PFGE) fragments of tcdA, tcdB, cdtB, and tcdC genes were amplified by PCR with oligonucleotides [14].…”

Section: Laboratory Analysismentioning

confidence: 99%

“…During the outbreak period, defined between January and July 2009, 389 cases were identified from the medical, emergency, and surgical wards, with isolates positive for both tcdA and tcdB [14]. Confirmation of the outbreak was declared during the third week of January, and the initial action implemented was the enforcement of general infection control measures.…”

Section: General Overview Of the Outbreakmentioning

confidence: 99%

Long term effect of infection control practices and associated factors during a major Clostridium difficile outbreak in Costa Rica

Wong-McClure

Ramírez-Salas

Mora-Brenes

et al. 2013

J Infect Dev Ctries

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Introduction: The C. difficile BI/NAP 1 hyper virulent strain has been responsible for the nosocomial outbreaks in several countries. The present study describes the infection control strategies utilized to achieve outbreak control as well as the factors associated with a C. difficile BI/NAP 1 hyper virulent strain outbreak in Costa Rica. Methodology: A descriptive analysis of the C. difficile outbreak was completed for the period of January 2007 to December 2010 in one affected hospital. An unmatched case-control study was subsequently performed to evaluate the association of exposure factors with C. difficile infection. Results: The pattern of the outbreak was characterized by a sharp increase in the incidence rate during the initial weeks of the outbreak, which was followed by a reduction in the incidence curve as several infection control measures were implemented. The C. difficile BI/NAP1 infection was associated with the prescription of antibiotics, in particular levofloxacin (OR: 9.3; 95%CI: 2.1-40.2), meropenem (OR: 4.9, 95%CI: 1.0-22.9), cefotaxime (OR: 4.3, 95%CI: 2.4-7.7), as well as a medical history of diabetes mellitus (OR: 2.9, 95%CI: 1.5-5.8). Conclusions: The infection control strategies implemented proved to be effective in achieving outbreak control and in maintaining the baseline C. difficile incidence rate following it. The reported C. difficile outbreak was associated with the prescription of broad-spectrum antibiotics and a medical history of diabetes.

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“…In Latin America, its first description was in Costa Rica, in 2009(Quesada-Gómez et al 2010. The spread of this strain highlighted the need for epidemiological investigations to characterize currently circulating strains.…”

Section: Introductionmentioning

confidence: 98%

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

Balassiano

Santos-Filho

Vital-Brazil

et al. 2010

Antonie van Leeuwenhoek

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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.

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Emergence of Clostridium difficile NAP1 in Latin America

Cited by 56 publications

References 11 publications

Fourteen-Genome Comparison Identifies DNA Markers for Severe-Disease-Associated Strains of Clostridium difficile

Fourteen-Genome Comparison Identifies DNA Markers for Severe-Disease-Associated Strains of Clostridium difficile

Long term effect of infection control practices and associated factors during a major Clostridium difficile outbreak in Costa Rica

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

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