Molecular epidemiology of <em>Clostridium difficile</em> in two tertiary care hospitals in Shandong Province, China

Abstract

PurposeThe incidence and severity of Clostridium difficile infection (CDI) have markedly increased over the past decade. However, there is very limited epidemiological data on CDI in China so far, specifically no data in Shandong Province. The aim of this study was to evaluate diagnostic algorithm for CDI and to gain data on molecular epidemiology of CDI in the Shandong Province of China.Materials and methodsNonrepetitive unformed fecal specimens (n=504) were investigated by the glutamate dehydrogenase (GDH), C. difficile toxin A&B (CDAB) tests and toxigenic culture. Furthermore, 85 isolates were characterized by toxin gene detection, multilocus sequence typing, ribotyping and antimicrobial susceptibility testing.ResultsThe algorithm of combining GDH and CDAB tests could define diagnosis of 54.2% CDI cases and excluded 90% of non-CDI. Further adding the toxigenic culture to the algorithm enhanced the detection sensitivity to 100%. Toxigenic strains comprised 84.7% of isolates, including A+B+CDT− (71.8%, 61/85), A−B+CDT− (11.8%, 10/85) and A+B+CDT+ (1.2%, 1/85) isolates. RT046/ST35 (13.9%, 10/72), RT014/ST2 (12.5%, 9/72) and RT017/ST37 (12.5%, 9/72) were the more common genotypes among toxigenic C. difficile strains. The clinical severity score of A−B+CDT− toxin genes genotype (3.50±0.85) was significantly higher than the A+B+CDT− type (2.59±0.93) (P<0.05). RT046/ST35 isolates were highly prevalent and had high clinical severity scores (3.80±0.92). Variations in resistance from different sequence types (STs) were observed. Toxigenic strains showed higher resistance rates to erythromycin, clindamycin and ciprofloxacin compared to nontoxigenic strains (P<0.05).ConclusionThe epidemiology of C. difficile in Shandong Province differed from other regions in China. Comprehensive optimized diagnosis strategy and continuous surveillance should be established and applied in order to curb the spread of toxigenic C. difficile strains, especially for hospitalized patients.

Molecular typing of Clostridioides difficile isolates from clinical and non‐clinical samples in Iran

“…This percentage is higher than what was shown previously for selected strains isolated from other studies (1.2%, Luo et al. (2018) ; 6%, Gonclaves et al. (2004) ; and 8.6%, Pituch et al.…”

“…The prevalence of tcdA À /tcdB + strains in Korea and China was much higher than that in our study (7.9%). Most researchers suggested that strains with toxin profile tcdA À /tcdB + belong to RT017 (29,33). In our study, three (7.9%) out of the 38 TXCD isolates were tcdA À /tcdB + belonging to RT017 (n = 2) and RT039 (n = 1; Table 1).…”

Characterization of Clostridioides difficile strains, the disease severity and the microbial changes they induce

“…These ndings suggest that ST distribution differs regionally across the world. The prevalence of strain ST37 found here matches its reported prevalence in two tertiary-care hospitals in Shandong Province, China, where it constituted 12.5% of the total isolates [16]. In that study, the strain was tcdA-negative, tcdB-positive, and cdtA/cdtB-negative (A − B + CDT−).…”

Characteristics of Clostridium difficile isolates and the burden of hospital-acquired Clostridium difficile infection in a tertiary teaching hospital in Chongqing, Southwest China

“…In addition, toxin types were associated with antibiotic resistance phenotypes. A-Bstrains were more resistant than A + B+ strains, while the latest data from two hospitals in Shangdong illustrated that non-toxigenic strains were more sensitive [42].…”