High prevalence of nontoxigenic Clostridium difficile isolated from hospitalized and non-hospitalized individuals in rural Ghana

Janssen, Iryna; Cooper, Paul; Gunka, Katrin; Rupnik, Maja; Wetzel, Daniela; Zimmermann, Ortrud; Groß, Uwe

doi:10.1016/j.ijmm.2016.09.004

Cited by 32 publications

(41 citation statements)

References 23 publications

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“…It is also worth noting that two of our non-toxigenic isolates of ribotype 084 were isolated from children, which is similar to the results of another African study [17]. The ribotype 084 was rarely reported in the developed countries.…”

Section: Discussionsupporting

confidence: 89%

First molecular characterisation and PCR ribotyping of Clostridium difficile strains isolated in two Algerian Hospitals

Djebbar

Sebaihia

Kuijper

et al. 2018

J Infect Dev Ctries

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Introduction: Clostridium difficile is the major etiological agent of nosocomial antibiotics associated diarrhoea. C. difficile infection is associated with considerable morbidity and mortality among hospitalized patients worldwide. Despite its known importance, there is no study on this important pathogen in Algeria. Methodology: In this prospective study, undertaken between 2013 and 2015, faecal specimens were collected from 159 hospitalized patients with antibiotic-associated diarrhoea in two tertiary health care hospitals in Chlef, Algeria. Faecal samples were cultured on CLO plates Agar with cefoxitin, cycloserine antibiotics and sodium taurocholate. C. difficile suspected colonies were analysed by multiplex PCR for the detection of the toxin genes. C. difficile isolates were analysed by PCR ribotyping and multi-locus tandem repeat analysis. Antimicrobial susceptibility was determined by the E-test method, according to the Clinical and Laboratory Standards Institute protocol. Results: C. difficile was cultured from 11 of 159 stool specimen (6.9%). Seven strains were toxigenic, mainly represented by the 020 and 014 PCR ribotypes and four non toxigenic belong to PCR ribotype 084. All 11 isolates were susceptible to both vancomycin and metronidazole and resistant to ciprofloxacin. Conclusions: This study, which reported for the first time C. difficile ribotypes circulating in Algerian health care facilities, could paves the way for further more comprehensive studies on this important pathogen, and could be useful to the local health authorities to implement a surveillance program of C. difficile in Algeria.

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Section: Discussionsupporting

confidence: 89%

First molecular characterisation and PCR ribotyping of Clostridium difficile strains isolated in two Algerian Hospitals

Djebbar

Sebaihia

Kuijper

et al. 2018

J Infect Dev Ctries

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“…Unnecessary antibiotic therapy would be avoided and antibiotic selective pressure could decrease, improving antibiotic stewardship . Among the reviewed studies, the frequency of asymptomatic carriage was 5% which is consistent with prior studies for both asymptomatic carriage and toxin‐negative strains both in HHDICs and LMHDICs .…”

Section: Discussionsupporting

confidence: 84%

Clostridium difficile infection in low‐ and middle‐human development index countries: a systematic review

Forrester

Cai

Mbanje

et al. 2017

Tropical Med Int Health

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Abstractobjective To describe the impact and epidemiology of Clostridium difficile infection (CDI) in lowand middle-human development index (LMHDI) countries.method Prospectively registered, systematic literature review of existing literature in the PubMed, Ovid and Web of Science databases describing the epidemiology and management of C. difficile in LMHDI countries. Risk factors were compared between studies when available.results Of the 218 abstracts identified after applying search criteria, 25 studies were reviewed in detail. The weighted pooled infection rate among symptomatic non-immunosuppressed inpatients was 15.8% (95% CI 12.1-19.5%) and was 10.1% (95% CI 3.0-17.2%) among symptomatic outpatients. Subgroup analysis of immunosuppressed patient populations revealed pooled infection rates similar to non-immunosuppressed patient populations. Risk factor analysis was infrequently performed.conclusions While the percentages of patients with CDI in LMHDI countries among the reviewed studies are lower than expected, there remains a paucity of epidemiologic data evaluating burden of C. difficile infection in these settings.keywords C. difficile infection, low-and middle-income countries, systematic review

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“…Less is known of the molecular epidemiology of C. difficile in South America, but RTs 027, 106, 012, 046, and 014/020 are reportedly the most common strains [31,33,34]. Similar to the current study, RT 017 (followed by RT 001) has also been found at high prevalence in South Africa [35], and in Ghana, Malawi, and Tanzania the few studies which performed molecular typing have shown a high prevalence of non-toxigenic strains [36,37], similar to reports from Southeast Asian countries [15].…”

Section: Discussionsupporting

confidence: 80%

Clostridioides difficile infection in the Asia-Pacific region

Collins

Sohn

et al. 2019

Emerging Microbes & Infections

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Clostridioides difficile causes healthcare-related diarrhoea in high-income countries. Highly resistant spores persist in healthcare facilities, primarily infecting patients who have recently received antimicrobials. C. difficile infection (CDI) has been studied in detail in North America and Europe; however, the epidemiology of CDI elsewhere, including the Asia-Pacific region, is largely unknown. A survey of CDI was performed in 13 Asia-Pacific countries. Epidemiological data on 600 cases were collected and molecular typing undertaken on 414 C. difficile isolates. Healthcare facilityassociated CDI comprised 53.6% of cases, while community-associated CDI was 16.5%. The median age of cases was 63.0 years and 45.3% were female, 77.5% had used antibiotics in the previous 8 weeks, most frequently thirdgeneration cephalosporins (31.7%), and 47.3% had used proton pump inhibitors. Recurrence (9.1%) and mortality (5.2%) rates were low, while complications including colitis or pseudomembranous colitis (13.8%), colectomy (0.4%), and toxic megacolon (0.2%) were uncommon. Common C. difficile strains were ribotypes 017 (16.7%), 014/020 (11.1%) and 018 (9.9%), with wide variation between countries. Binary toxin-positive strains of C. difficile were detected rarely. Overall, disease severity appeared mild, and mortality and recurrence were low. Continued education about, and surveillance of, CDI in Asia are required to reduce the burden of disease.

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High prevalence of nontoxigenic Clostridium difficile isolated from hospitalized and non-hospitalized individuals in rural Ghana

Cited by 32 publications

References 23 publications

First molecular characterisation and PCR ribotyping of Clostridium difficile strains isolated in two Algerian Hospitals

First molecular characterisation and PCR ribotyping of Clostridium difficile strains isolated in two Algerian Hospitals

Clostridium difficile infection in low‐ and middle‐human development index countries: a systematic review

Clostridioides difficile infection in the Asia-Pacific region

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