The Hypervirulent Strain of Clostridium Difficile: NAP1/B1/027 - A Brief Overview

Fatima, Rawish; Aziz, Muhammad

doi:10.7759/cureus.3977

Cited by 48 publications

(58 citation statements)

References 47 publications

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“…To note, the prevalence of RT027/ST1 reached 48% in hospitals in Poland with an outbreak of CDI during September 2011 to August 2013 ( Pituch et al, 2018 ). The hypervirulent RT027/ST1 contains several virulent factors, such as A/B toxins, TcdC gene mutation increasing the production of these toxins and hypersporulation increasing reproduction and spread of bacteria ( Fatima and Aziz, 2019 ). However, a retrospective analysis by Bauer et al exhibited that this strain was associated with a decreased odds of severe disease and did not increase in-hospital mortality or recurrence rate ( Bauer et al, 2017 ).…”

Section: Discussionmentioning

confidence: 99%

High Prevalence of Genetically Related Clostridium Difficile Strains at a Single Hemato-Oncology Ward Over 10 Years

et al. 2020

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Aims: Clostridium difficile ( C. difficile ) infection (CDI) is the main cause of healthcare-associated infectious diarrhea. We used whole-genome sequencing (WGS) to measure the prevalence and genetic variability of C. difficile at a single hemato-oncology ward over a 10 year period. Methods: Between 2008 and 2018, 2077 stool samples were obtained from diarrheal patients hospitalized at the Department of Lymphoma; of these, 618 were positive for toxin A/B. 140 isolates were then subjected to WGS on Ion Torrent PGM sequencer. Results: 36 and 104 isolates were recovered from 36 to 46 patients with single and multiple CDIs, respectively. Of these, 131 strains were toxigenic. Toxin gene profiles tcdA(+);tcdB(+);cdtA/cdtB(+) and tcdA(+);tcdB(+);cdtA/cdtB(-) were identified in 122 and nine strains, respectively. No isolates showed reduced susceptibility to metronidazole and vancomycin. All tested strains were resistant to ciprofloxacin, and 72.9, 42.9, and 72.9% of strains were resistant to erythromycin, clindamycin, or moxifloxacin, respectively. Multi-locus sequence typing (MLST) identified 23 distinct sequence types (STs) and two unidentified strains. Strains ST1 and ST42 represented 31 and 30.1% of all strains tested, respectively. However, while ST1 was detected across nearly all years studied, ST42 was detected only from 2009 to 2011. Conclusion: The high proportion of infected patients in 2008–2011 may be explained by the predominance of more transmissible and virulent C. difficile strains. Although this retrospective study was not designed to define outbreaks of C. difficile , the finding that most isolates exhibited high levels of genetic relatedness suggests nosocomial acquisition.

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Section: Discussionmentioning

confidence: 99%

High Prevalence of Genetically Related Clostridium Difficile Strains at a Single Hemato-Oncology Ward Over 10 Years

et al. 2020

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“…Clostridioides difficile is a challenging pathogen to treat from a clinical perspective. Its high rate of recurrence, ability to produce other toxins in addition to Toxins A and B, of which there is little data, as well as its several hypervirulent ribotypes, which contribute to the difficulty [ 9 ]. Risk factors that have been associated with the recurrent disease include age ≥ 65 (RR: 1.63, p <0.01), use of proton pump inhibitors (RR: 1.58, p <0.01), renal insufficiency (RR: 1.59, p <0.01), and additional antibiotics during follow-up (RR: 1.76, p <0.01) [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…Recurrence rates are 16.5 - 26%, 18.5 - 23.0%, and 14.1%, respectively [ 5 - 7 ]. Furthermore, with the emergence of resistant strains, as well as strains associated with severe diseases, such as the NAP1/BI/027 strain, the need to recognize and develop new effective medicines is of paramount importance [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Cadazolid vs Vancomycin for the Treatment of Clostridioides difficile Infection: Systematic Review with Meta-analysis

Aziz

Weissman

Fatima

et al. 2020

CCP

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Background:: Current guidelines recommend the use of vancomycin for the initial treatment of Clostridioides difficile Infection (CDI). Cadazolid, an experimental drug, has been utilized and compared in several studies with varying results. Methods:: A systematic literature search was performed using electronic databases [Medline, Google Scholar and Cochrane] for eligible studies. Randomized Controlled Trials (RCTs) comparing cadazolid with vancomycin for CDI treatment were included. Demographic variables and outcomes (CDI resolution, CDI recurrence, and adverse events) were collected. The primary outcome was clinical cure rate defined as the resolution of CDI at the end of a 10-day course. Results:: Two studies with three RCTs met the inclusion criteria with a total of 1283 patients with CDI who received either cadazolid 250 mg twice daily (624 patients) or vancomycin 125 mg four times daily (659 patients). Clinical cure rate at the end of the treatment was not statistically significant (pooled OR= 0.82; 95% CI = 0.61 to 1.11; p=0.20; I2= 0%). Sustained clinical response at clinical follow-up was also not significantly different (pooled OR = 1.14; 95% CI = 0.91 to 1.43; p=0.27; I2 = 0 %). Cadazolid had a lower recurrence rate than vancomycin (pooled OR = 0.71; 95% CI = 0.52 to 0.98; p=0.04; I2 = 13 %). Conclusion:: Cadazolid is non-inferior to vancomycin and offers a promising alternative for the treatment of CDI. More studies including RCTs and longitudinal studies with large and diverse patient population are needed to further confirm this. Furthermore, cadazolid should also be compared with fidaxomicin in a head-to-head trial to evaluate their efficacy for CDI.

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“…In recent years, several outbreaks have been reported with increased morbidity and mortality by a hypervirulent ribotype 027 strain of C. difficile (NAP1 strain) [17,18]. is strain shows high virulence due to a base pair frameshift mutation in the regulatory tcdC gene, which leads to the increased toxin production and pathogenicity [19]. Based on the fact that C. difficile can normally colonize, multiplex assays for the detection of enteric pathogens discussed in this article are not recommended for the diagnosis of C. difficile-associated disease.…”

Section: Molecular Tests For the Detection Of Toxigenic Clostridioidementioning

confidence: 99%

An Overview of the Molecular Methods in the Diagnosis of Gastrointestinal Infectious Diseases

Amjad

2020

International Journal of Microbiology

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Gastrointestinal infectious diseases are very common worldwide and an important cause of morbidity and mortality, particularly in infants in developing countries. Diarrhea and other intestinal infections are caused by a wide range of bacteria, viruses, protozoa, and parasites. Conventional diagnosis of these infections is performed by culture, microscopy, and antigen detection immunoassays. The traditional culture and microscopy procedures are time-consuming, lack sensitivity, and require special laboratory setup and well-trained staff. However, based on the advancement in the molecular diagnostics and with the introduction of commercially available tests, traditional diagnostic techniques have been continuously replaced by these newer rapid antigen detection and molecular-based methods. This review summarizes and discusses the availability, advantages, and disadvantages of molecular methods in the detection and identification of human gastrointestinal pathogens.

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The Hypervirulent Strain of Clostridium Difficile: NAP1/B1/027 - A Brief Overview

Cited by 48 publications

References 47 publications

High Prevalence of Genetically Related Clostridium Difficile Strains at a Single Hemato-Oncology Ward Over 10 Years

High Prevalence of Genetically Related Clostridium Difficile Strains at a Single Hemato-Oncology Ward Over 10 Years

Cadazolid vs Vancomycin for the Treatment of Clostridioides difficile Infection: Systematic Review with Meta-analysis

An Overview of the Molecular Methods in the Diagnosis of Gastrointestinal Infectious Diseases

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