Molecular Epidemiology and Risk Factors of Clostridium difficile ST81 Infection in a Teaching Hospital in Eastern China

Abstract

BackgroundThe prevalence of Clostridium difficile causes an increased morbidity and mortality of inpatients, especially in Europe and North America, while data on C. difficile infection (CDI) are limited in China.MethodsFrom September 2014 to August 2019, 562 C. difficile isolates were collected from patients and screened for toxin genes. Multilocus sequence typing (MLST) and antimicrobial susceptibility tests by E-test and agar dilution method were performed. A case group composed of patients infected with sequence type (ST) 81 C. difficile was compared to the non-ST81 infection group and non CDI diarrhea patients for risk factor and outcome analyses.ResultsThe incidence of inpatients with CDI was 7.06 cases per 10,000 patient-days. Of the 562 C. difficile isolates, ST81(22.78%) was the predominant clone over this period, followed by ST54 (11.21%), ST3 (9.61%), and ST2 (8.72%). Toxin genotype tcdA+tcdB+cdt- accounted for 50.18% of all strains, while 29.54% were tcdA-tcdB+cdt- genotypes. Overall, no isolate was resistant to vancomycin, teicoplanin or daptomycin, and resistance rates to meropenem gradually decreased during these years. Although several metronidazole-resistant strains were isolated in this study, the MIC values decreased during this period. Resistance rates to moxifloxacin and clindamycin remained higher than those to the other antibiotics. Among CDI inpatients, longer hospitalization, usage of prednisolone, suffering from chronic kidney disease or connective tissue diseases and admission to emergency ward 2 or emergency ICU were significant risk factors for ST81 clone infection. All-cause mortality of these CDI patients was 4.92%(n=18), while the recurrent cases accounted for 5.74%(n=21). The 60-day mortality of ST81-CDI was significantly higher than non-ST81 infected group, while ST81 also accounted for most of the recurrent CDI cases.ConclusionThis study revealed the molecular epidemiology and risk factors for the dominant C. difficile ST81 genotype infection in eastern China. Continuous and stringent surveillance on the emerging ST81 genotype needs to be initiated.

Assessment of independent comorbidities and comorbidity measures in predicting healthcare facility-onset Clostridioides difficile infection in Kenya

“…Previous studies comparing patients with and without underlying chronic kidney disease (CKD) noted that the former had a higher risk of initial and recurrent episodes of CDI [20,21]. Similarly, these findings were supported by a recent study that observed an almost fourfold increased risk (OR:3.68, CI: 1.63-8.31, p = 0.002) of developing CDI in patients with underlying CKD [22]. The reduced function of the kidney not only interferes with the elimination of the toxins from the body but also alters the functions of the intestinal microbiota and PLOS GLOBAL PUBLIC HEALTH activates systemic inflammation [23][24][25].…”

Complete Genome Sequencing and Comparative Phenotypic Analysis Reveal the Discrepancy Between Clostridioides difficile ST81 and ST37 Isolates

“…In Asia, the tcdA – tcdB + C. difficile strain ribotype 017/ST37 was previously reported to be the most epidemic clone ( Tang et al, 2016 ; Imwattana et al, 2019 ). Recently, however, numerous studies have demonstrated that another tcdA – tcdB + strain, ST81, has emerged as the predominant clone in northern and eastern China ( Qin et al, 2017 ; Cui et al, 2019 ; Cheng et al, 2020 ; Yang et al, 2020 ). In accordance with this, in our follow-up monitoring, the prevalence of ST81 was found to be remarkably higher than that of ST37 compared with our previous findings at the same institution in Shanghai ( Dong et al, 2014b ).…”

“…A systematic review in 2016 demonstrated that ST37, a tcdA -negative and tcdB -positive (A – B + ) strain, was most prevalent in mainland China ( Tang et al, 2016 ). However, several recent studies in Beijing and Shanghai found that the epidemic clone had been replaced by another tcdA -negative and tcdB -positive strain, ST81 ( Qin et al, 2017 ; Cui et al, 2019 ; Cheng et al, 2020 ; Yang et al, 2020 ), which has caused multiple nosocomial outbreaks. Isolates of C. difficile have been classified into five distinct phylogenetic lineages ( Janezic and Rupnik, 2015 ) based on the MLST database, where ST81 and ST37 belong to clade 4 and mainly correspond to ribotype 017 ( Wu et al, 2019 ).…”