A prospective study of community-associated Clostridium difficile infection in Kuwait: Epidemiology and ribotypes

Jamal, Wafaa; Pauline, Eunice M.; Rotimi, Vincent O.

doi:10.1016/j.anaerobe.2015.06.006

Cited by 23 publications

(14 citation statements)

References 42 publications

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“…On the other hand, the three highest individual prevalence estimates reported in or after the year 2000 included in the pooled prevalence were in Sudan in restaurant workers tested for renewal of work permit (70.3%), Tunisia in adults with diarrhoea (34.2%) (Al‐Gallas et al, ) and Saudi Arabia in a food poisoning outbreak at a wedding ceremony (64.5%) (Aljoudi et al, ). Moreover, there were several zero prevalence estimates reported in food handlers in Jordan (Abdel‐Dayem et al, ; Nimri & Meqdam, ), in children with and without GIT symptoms in Palestine (Laham et al, ) and in children attending outpatients clinics in Kuwait (Jamal et al, ). These zero prevalence estimates have a significant contribution in bringing the time‐related Salmonella prevalence down to 4.9% in studies conducted in or after the year 2000.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, there were several zero prevalence estimates reported in food handlers in Jordan (Abdel-Dayem et al, 2014;Nimri & Meqdam, 2004), in children with and without GIT symptoms in Palestine and in children attending outpatients clinics in Kuwait (Jamal et al, 2015). These zero prevalence estimates have a significant contribution in bringing the time-related Salmonella prevalence down to 4.9% in studies conducted in or after the year 2000.…”

Section: Discussionmentioning

confidence: 99%

“…TA B L E 2 (Continued) Jamsheer, Jamsheer, Yousif, Al-Otaibi, & Botta, 2002), Kuwait (Jamal, Pauline, Pauline, & Rotimi, 2015), Lebanon (Araj, Uwaydah, Uwaydah, & Alami, 1994) (Table 2).…”

Section: Scope Of Salmonella Prevalence Evidencementioning

confidence: 99%

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Prevalence of enteric non‐typhoidal Salmonella in humans in the Middle East and North Africa: A systematic review and meta‐analysis

Al‐Rifai

Chaabna

Denagamage

et al. 2019

Zoonoses and Public Health

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To enhance efforts related to controlling foodborne pathogens in the Middle East and North Africa (MENA), information on epidemiology of non‐typhoidal Salmonella enterica (hereafter termed “Salmonella”) is limited. We quantified the overall regional and country‐specific Salmonella prevalence in different human populations and identified the most common serotypes. Published literature of Salmonella prevalence was systematically reviewed and reported following the Preferred Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines. Pooled Salmonella prevalence measures were estimated using a random‐effects model. We identified 46 research reports that reported 84 Salmonella prevalence measures in 15 out of 24 countries in MENA. There were 252,831 tested humans with 6,356 Salmonella‐positive cases. The pooled Salmonella prevalence in MENA was estimated at 6.6% (95% confidence interval (CI): 5.4%–7.9%). The highest pooled Salmonella prevalence measures were in Morocco (17.9%, 95% CI: 5.7%–34.8%, 1997–2012), Tunisia (10.2%, 95% CI: 4.3%–18.0%, 1988–2009) and Sudan (9.2%, 95% CI: 6.5%–12.2%, 2006–2008), while the lowest were in Jordan (1.1%, 95% CI: 0.1%–3.0%, 1993–2010), Oman (1.2%, 95% CI: 1.2%–1.3%, 1998–2002) and Palestine (1.2%, 95% CI: 0.4%–2.1%, 1999–2011). In MENA, Salmonella pooled prevalence in gastrointestinal symptomatic, gastrointestinal asymptomatic and food handlers population groups was 13.0% (95% CI: 7.6%–19.6%), 11.4% (95% CI: 2.2%–25.7%) and 3.8% (95% CI: 1.0%–8.0%), respectively. Salmonella prevalence was 14.5% (95% CI: 8.7%–26.1%) in studies tested <100 subjects, whereas 4.6% (95% CI: 3.6%–5.8%) in studies tested ≥100 subjects. Salmonella Enteritidis (29.8%) and Typhimurium (23.6%) were the most common serotypes. Salmonella was a common foodborne pathogen in MENA countries, particularly in North African countries. Findings inform the scientific community, the public and the decision‐makers with Salmonella prevalence and gaps in evidence in MENA to support control and prevention strategies and could leverage more research studies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Prevalence of enteric non‐typhoidal Salmonella in humans in the Middle East and North Africa: A systematic review and meta‐analysis

Al‐Rifai

Chaabna

Denagamage

et al. 2019

Zoonoses and Public Health

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“…The frequency of toxigenic isolates tested in the current study (86.36%) was slightly higher than another study (84.2%) reported from Tehran, Iran [22] . In neighbouring countries such as Kuwait, the rate of toxigenic C. difficile was reported to be 0.54% to 64.6% [23] , [24] . This difference might be partly related to the sample size, the target population and mainly to the primer set used in the current study.…”

Section: Discussionmentioning

confidence: 99%

Pathogenicity locus determinants and toxinotyping of Clostridioides difficile isolates recovered from Iranian patients

Aliramezani

Talebi

Baghani

et al. 2018

New Microbes and New Infections

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Little is known about the toxin profiles, toxinotypes and variations of toxin Clostridioides difficile C (tcdC) in Iranian C. difficile isolates. A total of 818 stool specimens were obtained from outpatients (n = 45) and hospitalized patients (n = 773) in Tehran, Iran, from 2011 to 2017. The 44 C. difficile isolates were subjected to PCR of toxin C. difficile A (tcdA), toxin C. difficile B (tcdB), tcdA 3′-end deletion, toxinotyping and sequencing of the tcdC gene. Thirty-eight isolates (86.36%) were identified as tcdA and tcdB positive, and the remaining six isolates (13.63%) were nontoxigenic. All tcdA- and tcdB-positive isolates yielded an amplicon of 2535 bp by PCR for the tcdA 3′ end. Fourteen (36.84%), seventeen (44.73%) and seven (18.43%) isolates belonged to wild-type, toxin C. difficile C subclone3 (tcdC-sc3) and tcdC-A genotype of tcdC, respectively. Thirty-one isolates (81.57%) belonged to toxinotype 0, and seven isolates (18.42%) were classified as toxinotype V. This study provides evidence for the circulation of historical and hypervirulent isolates in the healthcare and community settings. Furthermore, it was also demonstrated that the tcdC-A genotype and toxinotype V are not uncommon among Iranian C. difficile isolates.

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“…In the Middle East, the hypervirulent strains RT027, RT078, RT001 and also RT126 were not found as the most prevalent RT, while one of the most common RT in Qatar, Kuwait, and Lebanon were RT258, RT139, and RT014, respectively. RT078 has not been found in those studies, but RT027 has been found in 1.3% and 0.9% of isolates in Qatar and Lebanon, respectively [18][19][20] . Based on the observed allelic diversity, CDR4 with DI = 0.945 had the most discriminatory power of the loci tested; a finding that is consistent with a previous report by Marsh et al 21 .…”

Section: Discussionmentioning

confidence: 78%

High prevalence of Clostridiodes diffiicle PCR ribotypes 001 and 126 in Iran

Baghani

Mesdaghinia

Kuijper

et al. 2020

Sci Rep

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Clostridium difficile is a leading causative agent of hospital-acquired and community-acquired diarrhea in human. This study aims to characterize the predominant C. difficile strains, RT001 and 126, circulating in Iranian hospitals in relation to resistant phenotypes, the antibiotic resistance genes, and their genetic relatedness. A total number of 735 faecal specimens were collected from patients suspected of CDI in Tehran hospitals. Typing and subtyping of the strains were performed using CE-PCR ribotyping and MLVA, respectively, followed by PCR assays for ARGs and indicators of Tns. Minimum inhibitory concentrations (MICs) of five antibiotics were determined by MIC Test Strips. Among 65 strains recovered from CDI patients, RT001 (32.3%) and RT126 (9.2%) were found as the most frequent ribotypes, and 64 MLVA types were identified. Using MLVA, RT001 and RT126 were subtyped into 6 and 4 groups, respectively. The vanA, nim, tetM, gyrA, gyrB genes were detected in 24.6%, 0%, 89.2%, 95.3%, and 92.3% of the strains, respectively. The indicators of Tns including vanHAX, tndX, and int were found in 0%, 3% and 29.2% of the strains, respectively. The most common amino acid (AA) alterations of GyrA and GyrB were related to substitutions of Thr82 → Val and Ser366 → Val, respectively. Resistance rate to metronidazole, vancomycin, tetracycline, ciprofloxacin, and moxifloxacin was 81.5%, 30.7%, 85%, 79%, and 74%, respectively. This study, for the first time revealed the subtypes of circulating RT001 and RT126 in Iran. It is of importance that the majority of the strains belonging to RT001 were multidrug resistant (MDR). This study also pointed to the intra-hospital dissemination of the strains belonging to RT001 and RT126 for short and long periods, respectively, using MLVA. The most important resistance phenotypes observed in this study was vancomycinresistant phenotypes. Resistance to metronidazole was also high and highlights the need to determine its resistance mechanisms in the future studies. Clostridium difficile is a leading causative agent of hospital-acquired (HA) and community-acquired (CA) diarrhea in human 1. Severe C. difficile infections (CDIs) are commonly associated with hypervirulent strains pertaining to PCR ribotypes (RTs) 027 and 078. The C. difficile RT001 is regarded to be a hypervirulent strain as well as RT078 2. C. difficile RT126 is considered as a hypervirulent strain that is genetically close to RT078 (identical patterns of PCR ribotyping) 3,4. The RT078 is one of the most common types of C. difficile isolated from human in Europe 2,3. The RT001 and RT072 associated with lethal CDI, are common in Europe 5,6. The RTs001/072 have almost identical patterns of PCR ribotyping and could be differentiated by multilocus variable-number tandem repeat analysis (MLVA) 7. Capillary electrophoresis (CE)-PCR ribotyping is currently employed as an appropriate alternative to agarose gel-based PCR ribotyping for epidemiological surveillance. However, it needs to be combined with MLVA in order to subtype the strain...

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A prospective study of community-associated Clostridium difficile infection in Kuwait: Epidemiology and ribotypes

Cited by 23 publications

References 42 publications

Prevalence of enteric non‐typhoidal Salmonella in humans in the Middle East and North Africa: A systematic review and meta‐analysis

Prevalence of enteric non‐typhoidal Salmonella in humans in the Middle East and North Africa: A systematic review and meta‐analysis

Pathogenicity locus determinants and toxinotyping of Clostridioides difficile isolates recovered from Iranian patients

High prevalence of Clostridiodes diffiicle PCR ribotypes 001 and 126 in Iran

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