Comparison of Clostridium difficile Ribotypes Circulating in Australian Hospitals and Communities

Abstract

Clostridium difficile infection (CDI) is becoming less exclusively a health care-associated CDI (HA-CDI). The incidence of community-associated CDI (CA-CDI) has increased over the past few decades. It has been postulated that asymptomatic toxigenic C. difficile (TCD)-colonized patients may play a role in the transfer of C. difficile between the hospital setting and the community. Thus, to investigate the relatedness of C. difficile across the hospital and community settings, we compared the characteristics of symptomatic and asymptomatic host patients and the pathogens from these patients in these two settings over a 3-year period. Two studies were simultaneously conducted; the first study enrolled symptomatic CDI patients from two tertiary care hospitals and the community in two Australian states, while the second study enrolled asymptomatic TCD-colonized patients from the same tertiary care hospitals. A total of 324 patients (96 with HA-CDI, 152 with CA-CDI, and 76 colonized with TCD) were enrolled. The predominant C. difficile ribotypes isolated in the hospital setting corresponded with those isolated in the community, as it was found that for 79% of the C. difficile isolates from hospitals, an isolate with a matching ribotype was isolated in the community, suggesting that transmission between these two settings is occurring. The toxigenic C. difficile strains causing symptomatic infection were similar to those causing asymptomatic infection, and patients exposed to antimicrobials prior to admission were more likely to develop a symptomatic infection (odds ratio, 2.94; 95% confidence interval, 1.20 to 7.14). Our findings suggest that the development of CDI symptoms in a setting without establishment of hospital epidemics with binary toxin-producing C. difficile strains may be driven mainly by host susceptibility and exposure to antimicrobials, rather than by C. difficile strain characteristics.

High prevalence ofClostridium difficileon retail root vegetables, Western Australia

“…Ribotypes 101 (40%; 6 of 15) and 137 (13Á3%; 2 of 15) were the two most prevalent RTs in lambs (Knight and Riley 2013b), RT 033 was the second most prevalent ribotype in both veal calves (19Á6%; 41 of 209; Knight et al 2013a) and piglets (13%;20/154;Knight et al 2015), while RT 237 is a pig strain unique to one piggery in WA (Knight et al 2015). All of these RTs of C. difficile have been isolated from human cases of CDI in Australia (Androga et al 2015;Furuya-Kanamori et al 2016;McGovern et al 2016).…”

New York City House Mice (Mus musculus) as Potential Reservoirs for Pathogenic Bacteria and Antimicrobial Resistance Determinants

“…The epidemiology of community-acquired C. difficile infection (CA-CDI), a major burden on the health care system, is not well understood ( 51 ). The majority of CDI cases are believed to cycle directly between hospitals and the community; in one study, 79% of isolates from health care-associated (HA) CDI cases matched those from the community ( 52 ). The maintenance and amplification of C. difficile by reservoirs in the urban environment may contribute to this cycle.…”

Molecular epidemiology and antimicrobial susceptibility of Clostridium difficile isolates from two Korean hospitals

“…In an Australian survey of the hospital-acquired and community-acquired CDIs, ribotypes 014/020, 002, 054, 056, and 070 were the most prevalent in 2010, and C . difficile isolates of ribotypes 014/020, 056, 002, and 018 were the prevalent between 2012 and 2014 [42, 43]. Regarding Asian countries, the most common ribotypes in China have been 017, 012, and 046 [44], whereas ribotypes 018, 001, 017, and 014/020 are prevalent in Japan and Korea [11, 14].…”