C. difficile ribotype 027 or 176?

Krutova, Marcela; Matejkova, Jana; Nyč, Otakar

doi:10.1007/s12223-014-0323-5

Cited by 28 publications

(22 citation statements)

References 5 publications

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“…Clostridium difficile ribotype 176 may be misinterpreted as ribotype 027 by GeneXpert ® C. difficile (Cepheid). Therefore, further molecular analysis such as ribotyping based on capillary electrophoresis is needed to better differentiate between C. difficile ribotypes 027 and 176 such that appropriate steps can be taken at the local and national levels to prevent outbreaks (28). In many places, C. difficile surveillance is not yet sufficient; thus, the number of outbreaks is increasing.…”

Section: Discussionmentioning

confidence: 99%

A Diagnostic Algorithm for the Detection of Clostridium difficile-Associated Diarrhea

Yoldaş¹,

Altındiş²,

Çufali³

et al. 2016

Balkan Med J

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Background: Clostridium difficile is a common cause of hospital-acquired diarrhea, which is usually associated with previous antibiotic use. The clinical manifestations of C. difficile infection (CDI) may range from mild diarrhea to fulminant colitis. Clostridium difficile should be considered in diarrhea cases with a history of antibiotic use within the last 8 weeks (community-associated CDI) or with a hospital stay of at least 3 days, regardless of the duration of antibiotic use (hospital-acquired CDI). Aims: This study investigated the frequency of CDI in diarrheic patients and evaluated the efficacy of the triple diagnostic algorithm that is proposed here for C. difficile detection. Study Design: Cross-sectional study. Methods: In this study, we compared three methods currently employed for C. difficile detection using 95 patient stool samples: an enzyme immunoassay (EIA) for toxin A/B (C. diff Toxin A+B; Diagnostic Automation Inc.; Calabasas, CA, USA), an EIA for glutamate dehydrogenase (GDH) (C. DIFF CHEK-60TM, TechLab Inc.; Blacksburg, VA, USA), and a polymerase chain reaction (PCR)-based assay (GeneXpert ® C. difficile; Cepheid, Sunnyvale, CA, USA) that detects C. difficile toxin genes and conventional methods as well. In this study, 50.5% of the patients were male, 50 patients were outpatients, 32 were from inpatient clinics and 13 patients were from the intensive care unit. Results:Of the 95 stool samples tested for GDH, 28 were positive. Six samples were positive by PCR, while nine samples were positive for toxin A/B. The hypervirulent strain NAP-1 and binary toxin was not detected. The rate of occurrence of toxigenic C. difficile was 5.1% in the samples. Cefaclor, ampicillin-sulbactam, ertapenem, and piperacillin-tazobactam were the most commonly used antibiotics by patients preceding the onset of diarrhea. Among the patients who were hospitalized in an intensive care unit for more than 7 days, 83.3% were positive for CDI by PCR screening. If the PCR test is accepted as the reference: C. difficile Toxin A/B ELISA sensitivity and specificity were 67% and 94%, respectively, and GDH sensitivity and specificity were 100% and 75%, respectively. Conclusion: Tests targeting C. difficile toxins are frequently applied for the purpose of diagnosing CDI in a clinical setting. However, changes in the temperature and reductant composition of the feces may affect toxin stability, potentially yielding false-negative test results. Therefore, employment of a GDH EIA, which has high sensitivity, as a screening test for the detection of toxigenic strains, may prevent false-negative results, and its adoption as part of a multistep diagnostic algorithm may increase accuracy in the diagnosis of CDIs.

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Section: Discussionmentioning

confidence: 99%

A Diagnostic Algorithm for the Detection of Clostridium difficile-Associated Diarrhea

Yoldaş¹,

Altındiş²,

Çufali³

et al. 2016

Balkan Med J

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“…In 2009, shortly afterward the 2008 study, the occurrence of ribotype 176 was reported in certain areas of the country (Eastern Bohemia and Moravia) [9]. This ribotype has persisted in the Czech Republic [8] and was also reported in Poland in 2008-13, which borders the country [10,11].…”

Section: Introductionmentioning

confidence: 98%

“…Ribotype 176 is closely related to 027 [6,7] and can be misidentified by commercial tests targeting a singlebase-pair deletion at nucleotide 117 in the C. difficiletcdC gene [8]. In 2009, shortly afterward the 2008 study, the occurrence of ribotype 176 was reported in certain areas of the country (Eastern Bohemia and Moravia) [9].…”

Section: Introductionmentioning

confidence: 99%

Clostridium difficile PCR ribotypes 001 and 176 – the common denominator of C. difficile infection epidemiology in the Czech Republic, 2014

et al. 2016

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In 2014, 18 hospitals in the Czech Republic participated in a survey of the incidence of Clostridium difficile infections (CDI) in the country. The mean CDI incidence was 6.1 (standard deviation (SD):7.2) cases per 10,000 patient bed-days and 37.8 cases (SD: 41.4) per 10,000 admissions. The mean CDI testing frequency was 39.5 tests (SD: 25.4) per 10,000 patient bed-days and 255.8 tests (SD: 164.0) per 10,000 admissions. A total of 774 C. difficile isolates were investigated, of which 225 (29%) belonged to PCR ribotype 176, and 184 isolates (24%) belonged to PCR ribotype 001. Multilocus variable-number tandem repeat analysis (MLVA) revealed 27 clonal complexes formed by 84% (190/225) of PCR ribotype 176 isolates, and 14 clonal complexes formed by 77% (141/184) of PCR ribotype 001 isolates. Clonal clusters of PCR ribotypes 176 and 001 were observed in 11 and 7 hospitals, respectively. Our data demonstrate the spread of two C. difficile PCR ribotypes within 18 hospitals in the Czech Republic, stressing the importance of standardising CDI testing protocols and implementing mandatory CDI surveillance in the country.

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“…(clade 2), as was published by Knetsch et al (Knetsch et al, 2012), as well as the presence of one base pair deletion at nucleotide position 117, which is a target site for commercial molecular systems (Krutova et al, 2014a;Mentula et al, 2015), (except WRT 413) as previously described above revealed a nonsense mutation C184T (Spigaglia and Mastrantonio, 2002;Curry et al, 2007). All these isolates (RT 023,027,126,176 and WRTs 413 and 438) revealed the presence of binary toxin genes, another important C. difficile virulence factor (Gerding et al, 2014).…”

Section: Discussionmentioning

confidence: 64%

Molecular characterisation of Czech Clostridium difficile isolates collected in 2013–2015

Krutova

Nyč

Matejkova

et al. 2016

International Journal of Medical Microbiology

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Clostridium difficile is a leading nosocomial pathogen and molecular typing is a crucial part of monitoring its occurrence and spread. Over a three-year period (2013)(2014)(2015), clinical Clostridium difficile isolates from 32 Czech hospitals were collected for molecular characterisation. Of 2,201 C. difficile isolates, 177 (8%) were non-toxigenic, 2,024 (92%) were toxigenic (tcdA and tcdB) and of these, 677 (33.5%) carried genes for binary toxin production (cdtA, cdtB). Capillary-electrophoresis (CE) ribotyping of the 2,201 isolates yielded 166 different CE-ribotyping profiles, of which 53 were represented by at least two isolates for each profile. Of these, 29 CE-ribotyping patterns were common to the Leeds-Leiden C. difficile reference strain library and the WEBRIBO database (83.7% isolates), and 24 patterns were recognized only by the WEBRIBO database (11.2% isolates). Isolates belonging to these 53 CE-ribotyping profiles comprised 94.9% of all isolates. The ten most frequent CE-ribotyping profiles were 176 (n=588, 26.7%), 001 (n=456, 20.7%), 014 (n=176, 8%), 012 (n=127, 5.8%), 017 (n=85, 3.9%), 020 (n=68, 3.1%), 596 (n=55, 2.5%), 002-like (n=45, 2.1%), 010 (n=35, 1.6%) and 078 (n=34, 1.6%). Multi-locus sequence typing (MLST) of seven housekeeping genes performed in one isolate of each of 53 different CE-ribotyping profiles revealed 40 different sequence types (STs). We conclude that molecular characterisation of Czech C. difficile isolates revealed a high diversity of CE-ribotyping profiles; the prevailing RTs were 001 (20.7%) and 176 (027-like, 26.7%).

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C. difficile ribotype 027 or 176?

Cited by 28 publications

References 5 publications

A Diagnostic Algorithm for the Detection of Clostridium difficile-Associated Diarrhea

A Diagnostic Algorithm for the Detection of Clostridium difficile-Associated Diarrhea

Clostridium difficile PCR ribotypes 001 and 176 – the common denominator of C. difficile infection epidemiology in the Czech Republic, 2014

Molecular characterisation of Czech Clostridium difficile isolates collected in 2013–2015

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