Colonisation and transmission of Clostridium difficile in healthy individuals examined by PCR ribotyping and pulsed-field gel electrophoresis

Kato, Hideaki; Kita, Hidefumi; Karasawa, Tadahiro; Maegawa, Tsuneo; Koino, Youko; Takakuwa, Hiroshi; Saikai, T.; Kobayashi, Kimiko; Yamagishi, Toshio; Nakamura, Shinichi

doi:10.1099/0022-1317-50-8-720

Cited by 121 publications

(115 citation statements)

References 12 publications

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“…Furthermore, the hypervirulent C. difficile ST-1 (ribotype 027) and ST-11 (ribotype 078) strains were not seen in our study. Based on a previous study (Kato et al, 2001), we suspected that cross-transmission among patients through healthcare workers and environmental contamination during long hospital stays were a source of CDI, but we did not find any clustering of cases that would indicate this.…”

Section: Discussionmentioning

confidence: 65%

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Risk factors, outcomes and epidemiology associated with Clostridium difficile infection in patients with haematological malignancies in a tertiary care hospital in China

Chen

et al. 2015

Journal of Medical Microbiology

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The purpose of this study was to evaluate the risk factors, outcomes and epidemiology associated with Clostridium difficile infection (CDI) in patients with haematological malignancies in a tertiary care hospital in China. C. difficile screening was performed on patients admitted for chemotherapy or haematopoietic stem cell transplantation between 2009 and 2013. C. difficile isolates were analysed by multilocus sequence typing, and a retrospective chart review was performed on all patients with a positive toxin assay. CDI was diagnosed in 21 haematologyoncology ward patients and 14 marrow transplantation service patients for a cumulative incidence of 1.89/1000 and 3.69/1000 patient-days, respectively. Univariate analyses showed that patients who received etoposide had an increased risk of CDI (odds ratio 4.25, 95 % confidence interval 1.32-13.64). There was only one patient death, for which CDI was not the primary cause. Ten sequence types (STs) were identified, of which ST-3 and ST-54 were the most common; the hypervirulent ST-1 (ribotype 027) and ST-11 (ribotype 078) C. difficile strains were not detected in the patients in this study. The incidence of CDI did not differ between patients receiving chemotherapy and those receiving haematopoietic stem cell transplantation. The only risk factor for chemotherapy patients was treatment with etoposide.

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Section: Discussionmentioning

confidence: 65%

“…difficile isolates were analysed by PCR to detect toxin A and B genes (tcdA and tcdB, respectively) as described by Kato et al (2001). The primer pairs were NK9-NK11 (1200 bp product) for the repetitive domain of tcdA, and NK104-NK105 (200 bp product) for tcdB.…”

Section: Methodsmentioning

confidence: 99%

Risk factors, outcomes and epidemiology associated with Clostridium difficile infection in patients with haematological malignancies in a tertiary care hospital in China

Chen

et al. 2015

Journal of Medical Microbiology

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“…Furthermore, the analysis was supported by culture of C. difficile and typing of isolates according to the recently developed reference method PCR ribotyping (49). Over the years many typing procedures for C. difficile have been used and evaluated, and PCR ribotyping has emerged as superior with regard to typeability, reproducibility, discriminatory power, stability, and epidemiological concordance (6,8,9,11,28,32,43,47). Our data, therefore, can also be used for comparative studies.…”

Section: Discussionmentioning

confidence: 92%

Molecular Epidemiology of Hospital-Associated and Community-Acquired Clostridium difficile Infection in a Swedish County

Norén¹,

Åkerlund

Bäck³

et al. 2004

J Clin Microbiol

146

120

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All episodes of Clostridium difficile associated diarrhea (CDAD) diagnosed in a defined population of 274,000 including one tertiary and two primary hospitals and their catchment areas were studied during 12 months. The annual CDAD incidence in the county was 97 primary episodes per 100,000, and 78% of all episodes were classified as hospital associated with a mean incidence of 5.3 (range, 1.4 to 6.5) primary episodes per 1,000 admissions. The incidence among hospitalized individuals was 1,300-fold higher than that in the community (33,700 versus 25 primary episodes per 100,000 persons per year), reflecting a 37-fold difference in antibiotic consumption (477 versus 13 defined daily doses [DDD]/1,000 persons/day) and other risk factors. Three tertiary hospital wards with the highest incidence (13 to 36 per 1,000) had CDAD patients of high age (median age of 80 years versus 70 years for other wards, P < 0.001), long hospital stay (up to 25 days versus 4 days), or a high antibiotic consumption rate (up to 2,427 versus 421 DDD/1,000 bed days). PCR ribotyping of C. difficile isolates available from 330 of 372 CDAD episodes indicated nosocomial acquisition of the strain in 17 to 27% of hospital-associated cases, depending on the time interval between index and secondary cases allowed (2 months or up to 12 months), and only 10% of recurrences were due to a new strain of C. difficile (apparent reinfection). In other words, most primary and recurring episodes were apparently caused by the patient's endogenous strain rather than by one of hospital origin. Typing also indicated that a majority of C. difficile strains belonged to international serotypes, and the distribution of types was similar within and outside hospitals and in primary and relapsing CDAD. However, type SE17 was an exception, comprising 22% of hospital isolates compared to 6% of community isolates (P ‫؍‬ 0.008) and causing many minor clusters and a silent nosocomial outbreak including 36 to 44% of the CDAD episodes in the three high-incidence wards.

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“…Colonization by C. difficile in adults varies with geographical location and between populations; carriage rates between 2 and 15% have been reported in different studies (7)(8)(9). Colonization in infants is much more common, but also variable, and 25 to 80% of infants harbor C. difficile (10)(11)(12)(13).…”

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confidence: 99%

Toxin-Producing Clostridium difficile Strains as Long-Term Gut Colonizers in Healthy Infants

et al. 2014

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c Clostridium difficile is a colonizer of the human gut, and toxin-producing strains may cause diarrhea if the infectious burden is heavy. Infants are more frequently colonized than adults, but they rarely develop C. difficile disease. It is not known whether strains of C. difficile differ in the capacity to colonize and persist in the human gut microbiota. Here, we strain typed isolates of C. difficile that had colonized 42 healthy infants followed from birth to >12 months of age by using PCR ribotyping of the 16S-23S rRNA intergenic spacer region. The isolates were also characterized regarding carriage of the toxin genes tcdA, tcdB, and cdtA/B and the capacity to produce toxin B in vitro. Most strains (71%) were toxin producers, and 51% belonged to the 001 or 014 ribotypes, which often cause disease in adults. These ribotypes were significantly more likely than others to persist for >6 months in the infant micobiota, and they were isolated from 13/15 children carrying such long-term-colonizing strains. Ribotype 001 strains were often acquired in the first week of life and attained higher population counts than other C. difficile ribotypes in newborn infants' feces. Several toxin-negative ribotypes were identified, two of which (GI and GIII) were long-term colonizers, each found in one infant. Our results suggest that the toxin-producing C. difficile ribotypes 001 and 014 have special fitness in the infantile gut microbiota. Toxin-producing strains colonizing young children for long time periods may represent a reservoir for strains causing disease in adults.

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Colonisation and transmission of Clostridium difficile in healthy individuals examined by PCR ribotyping and pulsed-field gel electrophoresis

Cited by 121 publications

References 12 publications

Risk factors, outcomes and epidemiology associated with Clostridium difficile infection in patients with haematological malignancies in a tertiary care hospital in China

Risk factors, outcomes and epidemiology associated with Clostridium difficile infection in patients with haematological malignancies in a tertiary care hospital in China

Molecular Epidemiology of Hospital-Associated and Community-Acquired Clostridium difficile Infection in a Swedish County

Toxin-Producing Clostridium difficile Strains as Long-Term Gut Colonizers in Healthy Infants

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