Epidemic<i>Clostridium difficile</i>Ribotype 027 in Chile

Hernández-Rocha, Cristian; Barra-Carrasco, Jonathan; Pizarro-Guajardo, Marjorie; Ibáñez, Patricio; Bueno, Susan M.; Sarker, Mahfuzur R.; Guzmán, Ana María; Álvarez-Lobos, Manuel; Paredes-Sabja, Daniel

doi:10.3201/eid1808.120211

Cited by 20 publications

(14 citation statements)

References 8 publications

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“…difficile NAP1/027 is associated with a severe disease presentation and high morbidity and mortality rates; therefore, it presents a major clinical and financial burden [ 6 ]. In Latin America, this strain has been found in Costa Rica and more recently in Chile [ 7 ]. In Mexico, studies have shown the clinical characteristics of patients with CDI demonstrating a significant risks of developing CDI following the use of H2 blockers, if they had a prior hospitalization within 12 weeks of diagnosis, if they had been in the intensive care unit, prior use of cephalosporin’s, fluoroquinolones [ 7 ] and clindamycin [ 7 ] but genetic analysis of Mexican isolates have not been published.…”

Section: Introductionmentioning

confidence: 99%

First Report of Clostridium difficile NAP1/027 in a Mexican Hospital

et al. 2015

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Background and Objective Clostridium difficile NAP1/ribotype 027 is associated with severe disease and high mortality rates. Our aim was to determine the prevalence of NAP1/ribotype 027 among C. difficile isolates in a tertiary care hospital, and review the main clinical data.MethodsWe included 106 stool samples from 106 patients. Samples were tested for A&B toxins and were cultured on CCFA agar. The genes tcdA, tcdB, tcdC, cdtA, and cdtB were amplified using PCR in clinical isolates. The tcdA 3’-end deletion analysis, PCR-ribotyping, and pulsed-field gel electrophoresis (PFGE) were also performed. Stool samples that were positive for culture were tested by the GeneXpert C. difficile assay. Clinical data were collected.ResultsThirty-six patients tested positive for A&B toxins; and 22 patients had positive culture for C. difficile, 14 of which tested positive for the A&B toxins and all 22 patients tested positive by the GeneXpert C. difficile assay. Risk factors included an average hospital stay of 16.1 days prior to toxin detection, average antibiotic use for 16.2 days, and a median of 3 antibiotics used. The 30-day crude mortality rate was 8.4%. Six of the 22 patients died, and 3 of those deaths were directly attributed to C. difficile infection. The majority of isolates, 90.9% (20/22), carried genes tcdB, tcdA, cdtA, and cdtB; and these strains carried the corresponding downregulator gene tcdC, with an 18-bp deletion. PFGE was performed on 17 isolates, and one main pattern was observed. Analysis of the ribotyping data showed similar results.ConclusionThe above findings represent the clonal spread of C. difficile in our institution, which mainly includes the NAP1/027 strain. This is the first report of C. difficile ribotype NAP1/027 in Mexico.

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Section: Introductionmentioning

confidence: 99%

First Report of Clostridium difficile NAP1/027 in a Mexican Hospital

et al. 2015

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“…It is remarkable that some common PCR ribotypes in Europe and North America, such as 002, 015, 045, and 150, seem to be rare in Brazil. Recently, some reports suggest the rapid emergence of the epidemic 027 strain in Latin America, with confirmed cases in Costa Rica, Panama, and Chile ( Hernández-Rocha et al 2012 , Quesada-Gómez et al 2012 , López-Ureña et al 2014 ). Anyway, this C. difficile ribotype is still not reported in animals and humans in Brazil.…”

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Clostridium difficile ribotypes in humans and animals in Brazil

Silva

Rupnik

Diniz

et al. 2015

Mem. Inst. Oswaldo Cruz

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Clostridium difficile is an emerging enteropathogen responsible for pseudomembranous colitis in humans and diarrhoea in several domestic and wild animal species. Despite its known importance, there are few studies aboutC. difficile polymerase chain reaction (PCR) ribotypes in Brazil and the actual knowledge is restricted to studies on human isolates. The aim of the study was therefore to compare C. difficileribotypes isolated from humans and animals in Brazil. Seventy-six C. difficile strains isolated from humans (n = 25), dogs (n = 23), piglets (n = 12), foals (n = 7), calves (n = 7), one cat, and one manned wolf were distributed into 24 different PCR ribotypes. Among toxigenic strains, PCR ribotypes 014/020 and 106 were the most common, accounting for 14 (18.4%) and eight (10.5%) samples, respectively. Fourteen different PCR ribotypes were detected among human isolates, nine of them have also been identified in at least one animal species. PCR ribotype 027 was not detected, whereas 078 were found only in foals. This data suggests a high diversity of PCR ribotypes in humans and animals in Brazil and support the discussion of C. difficile as a zoonotic pathogen.

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“…In 2008, RT 027 had reached Korea, Hong Kong, and Singapore, and by 2009 it had been reported in Australia and Costa Rica [23][24][25][26][27]. This was followed by RT 027 being isolated in New Zealand in 2010 [28]; in Chile in 2011 [29], in Panama in 2013 [30], and in China in 2014 [31] (Fig. 2).…”

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The Clostridium difficile PCR ribotype 027 lineage: a pathogen on the move

Valiente

Cairns

Wren

2014

Clinical Microbiology and Infection

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Clostridium difficile is a Gram-positive, spore-forming, human and animal pathogen that is the major cause of antibiotic-associated diarrhoea worldwide. The past decade has seen the rapid emergence of the hypervirulent PCR ribotype (RT) 027 complex, which has been associated with increases in the incidence and severity of disease and mortality. In this review, we describe the potential virulence factors that have been reported in strains from the RT 027 complex. We review the emergence, population structure, dissemination and evolution of this lineage.

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EpidemicClostridium difficileRibotype 027 in Chile

Cited by 20 publications

References 8 publications

First Report of Clostridium difficile NAP1/027 in a Mexican Hospital

First Report of Clostridium difficile NAP1/027 in a Mexican Hospital

Clostridium difficile ribotypes in humans and animals in Brazil

The Clostridium difficile PCR ribotype 027 lineage: a pathogen on the move

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