Molecular epidemiology and antimicrobial susceptibility of Clostridium difficile isolated from a university teaching hospital in Japan

Kuwata, Y.; Tanimoto, Shinichi; Sawabe, Etsuko; Shima, Mari; Takahashi, Yusuke; Ushizawa, Hiroto; Fujie, Toshihide; Koike, Ryuji; Tojo, Naoko; Saito, Ryoichi

doi:10.1007/s10096-014-2290-9

Cited by 52 publications

(47 citation statements)

References 29 publications

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“…difficile isolates of ribotypes 014/020, 056, 002, and 018 were the prevalent between 2012 and 2014 [42, 43]. Regarding Asian countries, the most common ribotypes in China have been 017, 012, and 046 [44], whereas ribotypes 018, 001, 017, and 014/020 are prevalent in Japan and Korea [11, 14]. We also found that most of the ribotypes were unique to a given hospital, with four ribotypes (AB7, AB15, AB32, and AB35) found in KNUH and seven ribotypes (AB9, AB18, AB24, AB25, AB42, AB46, and AB68) found in BPH.…”

Section: Discussionmentioning

confidence: 99%

Molecular epidemiology and antimicrobial susceptibility of Clostridium difficile isolates from two Korean hospitals

et al. 2017

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Clostridium difficile is one of the main etiological agents causing antibiotic-associated diarrhea. This study investigated the genetic diversity of 70 toxigenic C. difficile isolates from two Korean hospitals by employing toxinotyping, ribotyping, multilocus sequence typing (MLST), and pulsed-field gel electrophoresis (PFGE). Toxin gene amplification resulted in 68 A⁺B⁺ and two A-B+ isolates. Most isolates (95.7–100%) were susceptible to daptomycin, metronidazole, and vancomycin. Seventy C. difficile isolates were classified into five toxinotypes, 19 ribotypes, 16 sequence types (STs), and 33 arbitrary pulsotypes. All C. difficile isolates of ribotype 018 (n = 38) were classified into ST17, which was the most prevalent ST in both hospitals. However, C. difficile isolates of ST17 (ribotype 018) exhibited pulsotypes that differed by hospital. ST2 (ribotype 014/020), 8 (ribotypes 002), 17 (ribotype 018), and 35 (ribotypes 015) were detected in both hospitals, whereas other STs were unique to each hospital. Statistical comparison of the different typing methods revealed that ribotyping and PFGE were highly predictive of STs. In conclusion, our epidemiological study indicates that C. difficile infections in both hospitals are associated with the persistence of endemic clones coupled with the emergence of many unique clones. A combination of MLST with PFGE or ribotyping could be useful for monitoring epidemic C. difficile strains and the emergence of new clones in hospitals.

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Section: Discussionmentioning

confidence: 99%

Molecular epidemiology and antimicrobial susceptibility of Clostridium difficile isolates from two Korean hospitals

et al. 2017

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“…), but almost all C. difficile FQs-resistant strains show the substitution Thr82Ile in GyrA[Ackermann et al 2001;Dridi et al 2002;Spigaglia et al 2008aSpigaglia et al , 2011Kuwata et al 2015]. In vitro experiments have demonstrated the MXF and levofloxacin (LE) exposure induce high frequency of selection for GyrA and GyrB drug-resistant mutants in previously susceptible strains…”

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confidence: 99%

Recent advances in the understanding of antibiotic resistance in Clostridium difficile infection

Spigaglia¹

2015

Therapeutic Advances in Infection

226

275

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Clostridium difficile epidemiology has changed in recent years, with the emergence of highly virulent types associated with severe infections, high rates of recurrences and mortality. Antibiotic resistance plays an important role in driving these epidemiological changes and the emergence of new types. While clindamycin resistance was driving historical endemic types, new types are associated with resistance to fluoroquinolones. Furthermore, resistance to multiple antibiotics is a common feature of the newly emergent strains and, in general, of many epidemic isolates. A reduced susceptibility to antibiotics used for C. difficile infection (CDI) treatment, in particular to metronidazole, has recently been described in several studies. Furthermore, an increased number of strains show resistance to rifamycins, used for the treatment of relapsing CDI. Several mechanisms of resistance have been identified in C. difficile, including acquisition of genetic elements and alterations of the antibiotic target sites. The C. difficile genome contains a plethora of mobile genetic elements, many of them involved in antibiotic resistance. Transfer of genetic elements among C. difficile strains or between C. difficile and other bacterial species can occur through different mechanisms that facilitate their spread. Investigations of the fitness cost in C. difficile indicate that both genetic elements and mutations in the molecular targets of antibiotics can be maintained regardless of the burden imposed on fitness, suggesting that resistances may persist in the C. difficile population also in absence of antibiotic selective pressure. The rapid evolution of antibiotic resistance and its composite nature complicate strategies in the treatment and prevention of CDI. The rapid identification of new phenotypic and genotypic traits, the implementation of effective antimicrobial stewardship and infection control programs, and the development of alternative therapies are needed to prevent and contain the spread of resistance and to ensure an efficacious therapy for CDI.

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“…This study revealed the molecular epidemiology of C. difficile and risk factors for the detection of toxin gene-positive strains. In a previous Japanese study, the percentage of toxin gene-positive strains and CDT gene-positive strains was 73% and 2%, respectively [10]. In other Japanese study, CDT-gene positive strains was 5% [17].…”

Section: Discussionmentioning

confidence: 79%

Molecular epidemiology of Clostridioides difficile and risk factors for the detection of toxin gene-positive strains

Okada

Kaku

Kosai

et al. 2019

Journal of Infection and Chemotherapy

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a b s t r a c tIn this study, we investigated all Clostridioides difficile strains isolated from stool samples in Nagasaki University Hospital between January 2012 and December 2014. Toxin genes (tcdA, tcdB and cdtA/cdtB) were analyzed for multiplex PCR in a total of 213 strains. In the toxin gene-positive strain, PCR ribotyping was conducted using capillary gel electrophoresis-based PCR and the Webribo database. Patients' backgrounds were analyzed by departments, disorders, antimicrobials, and clinical dates. The positive rates of tcdA, tcdB, and cdtA/cdtB genes were 62.9%, 63.4%, and 2.8%, respectively. The most frequent PCR ribotype was 047 (14.1%), followed by 014/0 (11.1%) and 002/0 (8.2%). In univariate analysis, the risk factors for the detection of toxin gene-positive strains in patients were older age (p ¼ 0.0036), over ! 65 years old (p ¼ 0.0175), the patients hospitalized at Department of Digestive Surgery (P ¼ 0.0059), higher CRP level (P ¼ 0.0395), and lower albumin level (p ¼ 0.0014). In the multivariate analysis, the risk factor for detection of toxin gene-positive strains was the patients hospitalized at Department of Digestive Surgery (OR; 4.62, 95% CI; 1.18e18.0, p ¼ 0.0274). In this study, the percentage of toxin gene-positive and cdtA/cdtB gene-positive strains was almost the same as that reported in previous studies, but the ribotype was different. In addition, we revealed that the risk factor associated with the detection of toxin genepositive strains was the patients hospitalized at Department of digestive surgery.

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Molecular epidemiology and antimicrobial susceptibility of Clostridium difficile isolated from a university teaching hospital in Japan

Cited by 52 publications

References 29 publications

Molecular epidemiology and antimicrobial susceptibility of Clostridium difficile isolates from two Korean hospitals

Molecular epidemiology and antimicrobial susceptibility of Clostridium difficile isolates from two Korean hospitals

Recent advances in the understanding of antibiotic resistance in Clostridium difficile infection

Molecular epidemiology of Clostridioides difficile and risk factors for the detection of toxin gene-positive strains

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