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

Abstract

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.

Toxin genotypes, antibiotic resistance and their correlations in Clostridioides difficile isolated from hospitals in Xi’an, China

“…The main toxin genotype was found to be tcdA + tcdB + cdtA-/B- , accounting for 74.3% (116/156), which is consistent with the 69-77% ratio in eastern China [ 15 – 17 ]. This ratio is lower than the proportion of 77-94% in East Asian countries such as South Korea [ 21 – 23 ], and higher than the proportion of document coverage in Greece, Iran, Saudi Arabia, and Thailand (27-65%) [ 18 , 24 – 26 ], indicating that the distribution of toxin genes varies greatly in between countries and regions. In this study, we isolated 27 tcdA-B + strains (17.3%, 27/156), and according to relevant literature, they may have higher resistance rates to a variety of antibiotics [ 27 ].…”