Molecular characteristics of Clostridium difficile strains from patients with a first recurrence more than 8 weeks after the primary infection (original) (raw)
Related papers
Molecular and Cellular Probes, 2016
Background/Purpose: Nearly all published studies of recurrent Clostridium difficile infections (CDI) report recurrent CDI within 8 weeks after the primary infection. This study explored the molecular characteristics of C. difficile isolates from the first recurrent CDI more than 8 weeks after the primary infection. Methods: Consecutive hospitalized patients with a recurrent CDI more than 8 weeks after a primary infection were enrolled prospectively from January 2008 to February 2011. All C. difficile isolates of the primary and recurrent infections were collected and subjected to polymerase chain reaction ribotyping and antimicrobial susceptibility testing. Results: There were 62 cases of CDI in this study, which included 32 cases (51.6%) of recurrence due to the same ribotype of C. difficile, 26 (41.9%) cases due to a different ribotype, and four (6.5%) cases with 2e4 recurrences due to the same or different strains. One hundred and forty C. difficile isolates were obtained, which included 62 primary CDI isolates and 78 recurrent isolates. Ribotype 020 was the most common C. difficile strain in primary and recurrent infections. Ribotype 001 accounted for 15.4% (10/78) of recurrent infections and 3.2% (2/ 62) of primary infections (p Z 0.0447). The minimum inhibitory concentration at 90% (MIC 90
Anaerobe, 2018
Recurrence of Clostridium difficile infection (CDI) places a major burden on the healthcare system. Previous studies have suggested that specific C. difficile strains, or ribotypes, are associated with severe disease and/or recurrence. However, in some patients a new strain is detected in subsequent infections, complicating longitudinal studies focused on strain differences that may contribute to disease outcome. We examined ribotype composition over time in patients who did or did not develop recurrence to examine infection with multiple C. difficile ribotypes (mixed infection), during the course of infection. Using a retrospective patient cohort, we isolated and ribotyped a median of 36 C. difficile colonies from 61 patients (105 total samples) at initial infection, recurrence (a second case of CDI within 15-56 days of initial infection), and reinfection (a second case of CDI after 56 days of initial infection). We observed mixed infection in 78.6% of samples at initial infection ...
Clinical Infectious Diseases, 2009
Background. The molecular epidemiology of endemic and outbreak Clostridium difficile strains across time is not well known. Methods. HindIII restriction endonuclease analysis (REA) typing was performed on available clinical C. difficile isolates from 1982 to 1991. Results. The annual incidence of C. difficile infection (CDI) ranged from 3.2 to 9.9 cases per 1000 discharges and was significantly higher in 1982, 1983, 1985, and 1991 (high-incidence years) than in other years (mean ע standard deviation number of cases for the high-vs the low-incidence years, and ; 121.8 ע 20.4 70.0 ע 15.0 P p). A total of 696 (76.6%) of 908 C. difficile isolates were available for REA typing over the 10-year period. .002 Large clusters (у10 CDI cases in consecutive months) were caused by REA types B1 and B2 in 1982 and 1983, F2 and B1 in 1985, and K1 in 1991 (high-incidence years). Small clusters of 4-9 CDI cases in consecutive months were caused by REA types G1 (1984), Y4 and Y6 (1987), Y2 (1988), L1 (1989), Y1 (1990), and K1 (1991). Current epidemic REA group BI (unrelated to type B1) was isolated 6 times, twice in 1984, 1988, and 1990. Conclusions. Years with a high incidence of CDI were associated with large clusters of specific REA types that changed yearly. The molecular epidemiology of CDI in this hospital was characterized by a wide diversity of C. difficile types and an ever-changing dominance of specific C. difficile types over time. The current epidemic BI group was found sporadically on 6 occasions. A changing CDI molecular epidemiology should be expected in the future. Clostridium difficile infection (CDI) is the most commonly diagnosed cause of hospital-acquired infectious diarrhea [1]. Current hospital costs associated with the disease are estimated at US $3.2 billion [2]. At large medical centers, CDI is typically an endemic infection, with outbreaks or periodic increases in CDI rates occurring sporadically [3]. Although certain CDI outbreaks have been associated with the emergence of new and possibly clinically distinct strains [4, 5], little is known about the longitudinal epidemiology of endemic
Clinical Infectious Diseases, 2009
Background. The molecular epidemiology of endemic and outbreak Clostridium difficile strains across time is not well known. Methods. HindIII restriction endonuclease analysis (REA) typing was performed on available clinical C. difficile isolates from 1982 to 1991. Results. The annual incidence of C. difficile infection (CDI) ranged from 3.2 to 9.9 cases per 1000 discharges and was significantly higher in 1982, 1983, 1985, and 1991 (high-incidence years) than in other years (mean ע standard deviation number of cases for the high-vs the low-incidence years, and ; 121.8 ע 20.4 70.0 ע 15.0 P p). A total of 696 (76.6%) of 908 C. difficile isolates were available for REA typing over the 10-year period. .002 Large clusters (у10 CDI cases in consecutive months) were caused by REA types B1 and B2 in 1982 and 1983, F2 and B1 in 1985, and K1 in 1991 (high-incidence years). Small clusters of 4-9 CDI cases in consecutive months were caused by REA types G1 (1984), Y4 and Y6 (1987), Y2 (1988), L1 (1989), Y1 (1990), and K1 (1991). Current epidemic REA group BI (unrelated to type B1) was isolated 6 times, twice in 1984, 1988, and 1990. Conclusions. Years with a high incidence of CDI were associated with large clusters of specific REA types that changed yearly. The molecular epidemiology of CDI in this hospital was characterized by a wide diversity of C. difficile types and an ever-changing dominance of specific C. difficile types over time. The current epidemic BI group was found sporadically on 6 occasions. A changing CDI molecular epidemiology should be expected in the future. Clostridium difficile infection (CDI) is the most commonly diagnosed cause of hospital-acquired infectious diarrhea [1]. Current hospital costs associated with the disease are estimated at US $3.2 billion [2]. At large medical centers, CDI is typically an endemic infection, with outbreaks or periodic increases in CDI rates occurring sporadically [3]. Although certain CDI outbreaks have been associated with the emergence of new and possibly clinically distinct strains [4, 5], little is known about the longitudinal epidemiology of endemic
Clinical Infectious Diseases, 2013
A c c e p t e d M a n u s c r i p t 2 A number of DNA-banding based typing systems for classifying Clostridium difficile isolates have been devised including PCR ribotyping, restriction endonuclease analysis (REA), and pulse field gel electrophoresis (PFGE) . PCR ribotyping was developed in Wales and is commonly used in Europe, whereas REA and PFGE have been used more commonly in North America. In addition, toxinotyping which is based on amplification of regions within the pathogenicity locus (PaLoc) for toxins A and B has been used to describe "toxin variant" strains whose PaLoc genes differ from the standard or toxinotype "0" PaLoc to which most PCR ribotypes, REA groups, and PFGE types belong . The aforementioned DNA-banding typing systems are invaluable for discriminating isolates from each other, but do not provide meaningful evolutionary analyses.
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 2016
Clostridium difficile infection (CDI) represents a great healthcare burden in developed countries. The emergence of the epidemic PCR ribotype (RT) 027 and its acquired fluoroquinolones resistance have accentuated the need for an active surveillance of CDI. Here we report the first countrywide study of CDI in Portugal with the characterization of 498 C. difficile clinical isolates, from 20 hospitals, comprising four regions in Portugal, regarding RT, virulence factors and antimicrobial susceptibility. We identified 96 RTs with marked variations between and within regions, as only six RTs appeared in all four regions. RT027 was the most frequent RT overall (18.5%) and among healthcare facility-associated isolates (19.6%), while RT014 was the most common among community-associated isolates (12%). The North showed a high RT diversity among isolates and a low moxifloxacin (MXF) resistance rate (11.9%), being the only region in which RT027 was not predominant. In contrast, the isolates fr...
Journal of Clinical Microbiology, 2011
Clostridium difficile strain NAP1/027 (North American pulsed-field gel electrophoresis [PFGE] type 1 and PCR ribotype 027 [R027]) has been associated with recent outbreaks in North America and Europe. It has been associated with more severe disease symptoms, higher mortality rates, and greater risk of relapse. This strain is thought to produce more toxins and sporulate to higher levels. However, recent studies suggest that this may not always be the case. The objective of our study was to assess, in a nonoutbreak situation, whether specific strains, such as NAP1/027, were associated with more severe disease symptoms, higher toxin production, and/or greater sporulation in vitro . We isolated and characterized C. difficile strains from 21 patients with mild to moderate, severe, or complicated symptoms of C. difficile infection (CDI). The isolates were characterized by different molecular typing methods, including PCR ribotyping, tandem repeat sequence typing (TRST), and sequencing of ...
Journal of Clinical Microbiology, 2008
Clostridium difficile is the bacterium most commonly surmised to cause antimicrobial- and hospital-associated diarrhea in developed countries worldwide, and such infections are thought to be increasing in frequency and severity. A laboratory-based study was carried out to characterize C. difficile strains isolated from persons in Ontario, Canada, during 2004 to 2006 according to toxin type (enterotoxin A, cytotoxin B, and binary toxin [CDT]), tcdC gene characterization, ribotyping, pulsed-field gel electrophoresis, and toxinotyping. Clostridium difficile was isolated from 1,080/1,152 (94%) samples from 21 diagnostic laboratories. Isolates with toxin profiles A + B + CDT − , A + B + CDT + , A − B + CDT − , and A − B + CDT + accounted for 63%, 34%, 2.4%, and 0.6% of isolates, respectively. Alterations in tcdC were detected in six different ribotypes, including ribotype 027. A total of 39 different ribotypes were identified, with ribotype 027/North American pulsotype 1 (NAP1), an inter...
Journal of Medical Microbiology, 2015
Clostridium difficile infection (CDI) leads to considerable morbidity and mortality among hospitalized patients. Faecal specimens from 1110 hospitalized patients suspected for CDI were cultured for isolation of C. difficile and characterization of virulence genes. PCR was carried out for toxigenic genes tcdA, tcdB, cdtA and cdtB and PCR-RFLP for fliC and slpA genes. Of 174 (15.7 %) C. difficile isolates, 121 (69.5 %) were toxigenic, amongst which 68 (56.2 %) also had both tcdA and tcdB genes. The remaining 53 (43.8 %) of the isolates also had at least one of the toxin genes. Binary toxin genes (cdtA and cdtB) with only one of the two components were present in 16 (9.2 %) of the 174 isolates. The other virulence genes-fliC and slpA-were present in 100 % of the isolates. The most frequent PCR-RFLP type of fliC gene was type I (n5101), followed by type VII (n549) and type III (n524). The slpA gene presented with three combinations of patterns. Characterization of virulence genes in C. difficile isolates is of extreme importance for epidemiological surveillance and control of outbreaks owing to the capacity of this bacterium to adapt to new environmental circumstances, leading to the emergence of new epidemic strains.