First Report of Clostridium difficile NAP1/027 in a Mexican Hospital

Abstract

Background and Objective Clostridium difficile NAP1/ribotype 027 is associated with severe disease and high mortality rates. Our aim was to determine the prevalence of NAP1/ribotype 027 among C. difficile isolates in a tertiary care hospital, and review the main clinical data.MethodsWe included 106 stool samples from 106 patients. Samples were tested for A&B toxins and were cultured on CCFA agar. The genes tcdA, tcdB, tcdC, cdtA, and cdtB were amplified using PCR in clinical isolates. The tcdA 3’-end deletion analysis, PCR-ribotyping, and pulsed-field gel electrophoresis (PFGE) were also performed. Stool samples that were positive for culture were tested by the GeneXpert C. difficile assay. Clinical data were collected.ResultsThirty-six patients tested positive for A&B toxins; and 22 patients had positive culture for C. difficile, 14 of which tested positive for the A&B toxins and all 22 patients tested positive by the GeneXpert C. difficile assay. Risk factors included an average hospital stay of 16.1 days prior to toxin detection, average antibiotic use for 16.2 days, and a median of 3 antibiotics used. The 30-day crude mortality rate was 8.4%. Six of the 22 patients died, and 3 of those deaths were directly attributed to C. difficile infection. The majority of isolates, 90.9% (20/22), carried genes tcdB, tcdA, cdtA, and cdtB; and these strains carried the corresponding downregulator gene tcdC, with an 18-bp deletion. PFGE was performed on 17 isolates, and one main pattern was observed. Analysis of the ribotyping data showed similar results.ConclusionThe above findings represent the clonal spread of C. difficile in our institution, which mainly includes the NAP1/027 strain. This is the first report of C. difficile ribotype NAP1/027 in Mexico.

Circulation of Highly Drug-Resistant Clostridium difficile Ribotypes 027 and 001 in Two Tertiary-Care Hospitals in Mexico

“…In our study, ribotype 027 was the predominant strain, accounting for 67.7% of the cases; this ribotype is considered epidemic and has been reported worldwide . In previous publications we have found 027 strain as the predominant ribotype in our settings 18,19 , the latter is in contrast to diverse studies were there is a high diversity of ribotypes and 027 stains account for less than 30% [20][21][22] . The second most frequent ribotype was 001, accounting for 14.5% of the cases; this ribotype is the main ribotype circulating in Korea 23 , Czech Republic 2 , Croatia 24 , and Slovakia 25 , however, this is the first report on ribotype 001 circulation in Mexico.…”

Comparative Genome Analysis and Global Phylogeny of the Toxin Variant Clostridium difficile PCR Ribotype 017 Reveals the Evolution of Two Independent Sublineages

“…The global emergence of the RT027 strain was responsible for multiple outbreaks and increased disease severity in Canada and the United States in 2001 ( 4 ). This strain has since spread to South America ( 5 – 7 ), China ( 8 ), Japan ( 9 ), Hong Kong ( 10 ), South Korea ( 11 , 12 ), Taiwan ( 13 ), Singapore ( 14 ), Australia ( 15 , 16 ), Saudi Arabia ( 17 ), Israel ( 18 ), New Zealand ( 19 ), and throughout Europe ( 5 , 20 – 28 ). Although RT027 remains the dominant clone in the United States, Europe has seen a decline in RT027 with a simultaneous increase in other virulent RTs, such as RT017 and RT078 ( 29 ).…”

High sporulation and overexpression of virulence factors in biofilms and reduced susceptibility to vancomycin and linezolid in recurrent Clostridium [Clostridioides] difficile infection isolates

“…No difference in ribotype was found between the R-CDI and NR-CDI groups. In our population, 027 strains are associated with higher mortality rates and greater probability of R-CDI [37].…”