Epidemiology of Clostridium difficile infection in hospitalized adults and the first isolation of C. difficile PCR ribotype 027 in central China

Abstract

Background Clostridium difficile infection (CDI) is an emerging healthcare problem in the world. The purpose of this study was to perform a systematic epidemiological research of CDI in Tongji hospital, the central of China. Methods Stool samples from hospitalized adults suspected of CDI were enrolled. The diagnosis of CDI were based on the combination of clinical symptoms and laboratory results. Clinical features of CDI and non-CDI patients were compared by appropriate statistical tests to determine the risk factors of CDI. Multilocus sequence typing (MLST) was employed for molecular epidemiological analysis. Susceptibility testing and relevant antimicrobial agent resistance genes were performed as well. Results From June 2016 to September 2017, 839 hospitalized adults were enrolled. Among them, 107 (12.8%, 107/839) patients were C. difficile culture positive, and 73 (8.7%, 73/839) were infected with toxigenic C. difficile (TCD), with tcdA + tcdB+ strains accounting for 90.4% (66/73) and tcdA-tcdB+ for 9.6% (7/73). Meanwhile, two TCD strains were binary toxin positive and one of them was finally identified as CD027. Severe symptoms were observed in these two cases. Multivariate analysis indicated antibiotic exposure ( p = 0.001, OR = 5.035) and kidney disease ( p = 0.015, OR = 8.329) significantly increased the risk of CDI. Phylogenetic tree analysis demonstrated 21 different STs, including one new ST (ST467); and the most dominant type was ST54 (35.6%, 26/73). Multidrug-resistant (MDR) TCD were 53.4% (39/73); resistance to ciprofloxacin, erythromycin, and clindamycin were > 50%. Other antibiotics showed relative efficiency and all strains were susceptible to metronidazole and vancomycin. All moxifloxacin-resistant isolates carried a mutation in GyrA (Thr82 → Ile), with one both having mutation in GyrB (Ser366 → Ala). Conclusions Knowledge of epidemiological information for CDI is limited in China. Our finding indicated tcdA + tcdB+ C. difficile strains were the dominant for CDI in our hospital. Significant risk factors for CDI in our setting appeared to be antibiotic exposure and kidney disease. Metronidazole and vancomycin were still effective for CDI. Although no outbreak was observed, the first isolation of CD027 in center China implied the potential spread of this hypervirulent clone. Further studies are needed to enhance our understanding of the epidemiology of CDI in China. Electronic supplementary material The online version of this article (10.1186/s12879-019-3841-6) contains supplementary material, which is available to authorized users.

High Prevalence of Multidrug-Resistant Clostridioides difficile Following Extensive Use of Antimicrobials in Hospitalized Patients in Kenya

“…Many of the C. difficile strains isolated from this patient population were highly resistant to rifampicin, clindamycin, erythromycin, ciprofloxacin, and ceftriaxone, and a large proportion were multidrug-resistant. Similar findings where more than half of the C. difficile isolates recovered were MDR have been associated with outbreaks ( Obuch-Woszczatyński et al., 2014 ; Krutova et al., 2015 ; Spigaglia, 2016 ; Ramírez-Vargas et al., 2017 ; Carman et al., 2018 ; Zhou et al., 2019 ). These findings highlight the significance of this pathogen in an African population previously considered to be at low CDI risk ( Roldan et al., 2018 ).…”

Chromosomal Resistance to Metronidazole inClostridioides difficilecan be Mediated By Epistasis Between Iron Homeostasis and Oxidoreductases

“…C. difficile was found to carry adjacent mutS and mutL genes (CD630_19770 and CD630_19760), in addition to the mutS homolog mutS2 (CD630_07090). To construct a C. difficile mutator, we chose the strain ATCC 700057 (17) because it is non-pathogenic, lacking the toxin genes tcdA and tcdB (18), and is widely used for antibiotic susceptibility testing (12). We individually deleted mutS, mutL, mutS2 and the entire mutSL operon by allelic exchange using pMTL-SC7215; deletions were confirmed by PCR (19).…”

Characteristics of Clostridioides difficile infection in inflammatory bowel disease

“…Recently, investigations carried out in Chinese hospitals revealed that ST54 was the predominant type of CDI in diarrhea patients [31,32]. Also, according to our previous meta-analysis about the domestic molecular epidemiology, the epidemic strain of C. di cile isolated from diarrhea patients were mainly ST3, ST37 and ST54, accounting for 18.1%, 17.2% and 16.7%, respectively.…”