Epidemiology of Clostridium difficile infections in a tertiary-care hospital in Korea

Abstract

To survey healthcare-associated Clostridium difficile infection (HA-CDI) in a 900-bed tertiary-care hospital, we prospectively investigated the epidemiology of CDI and distribution of PCR-ribotypes. From February 2009 through January 2010, all patients with HA-CDI were enrolled. Epidemiological information and prescription records for antibiotics were collected. The C. difficile isolates were characterized using reference strains and were tested for antibiotic susceptibility. During the survey, incidence of HA-CDI was 71.6 per 100 000 patient-days. In total, 140 C. difficile isolates were obtained from 166 patients with HA-CDI. The PCR-ribotyping yielded 38 distinct ribotypes. The three most frequently found ribotypes made up 56.4% of all isolates; they comprised 37 isolates (26.4%) of PCR-ribotype 018, 22 (15.7%) of toxin A-negative PCR-ribotype 017, and 20 (14.3%) of PCR-ribotype 001. Clostridium difficile PCR-ribotype 018 was present in all departments throughout the hospital during the 11 months, whereas ribotype 017 and ribotype 001 appeared mostly in the pulmonary department. Hypervirulent C. difficile PCR-ribotype 027 was detected in 1 month on two wards. The incidence of CDI in each department showed a seven-fold difference, which correlated significantly with the amount of prescribed clindamycin (R = 0.783, p 0.013) or moxifloxacin (R = 0.733, p 0.025) in the departments. The rates of resistance of the three commonest ribotypes to clindamycin and moxifloxacin were significantly higher than those of other strains (92.1% versus 38.2% and 89.5% versus 27.3%, respectively). CDI is an important nosocomially acquired infection and this study emphasizes the importance of implementing country-wide surveillance to detect and control CDI in Korea.

Low Prevalence of Clostridium difficile in Slaughter Pigs in Korea

“…Recently, Kim et al found that ribotypes 018, 017, and 001 are predominant in humans in Korea (15), with RT078 being the most common binary toxin-positive strain in Korea (3.1%); this is consistent with other reports that indicate the worldwide prevalence of RT078 in community (14). In this study, only RT078 was identified, consistent with the predominance of this ribotype in pigs worldwide (5).…”

To the Editor: Molecular epidemiology of toxigenic Clostridium difficile isolates in Korea

“…018, 017, and 014, while the other half comprised a broad spectrum of ribotypes. PCR ribotype 001, which is the prevalent type in Europe, was not identified in Korea in either study, whereas PCR ribotype 014 was one of the dominant strains, as in Western countries and other regions of east Asia [2,5]. In this study, there was no PCR ribotype 027, a representative hypervirulent type.…”

“…A partially deleted toxin A gene that could not be amplified using commercial real-time PCR was detected in six specimens (8·96%), which were all PCR ribotype 017 known to be prevalent in east Asia [4,5]. We therefore suggest that any PCR ribotype 017 strain described as toxin A negative and B positive be examined carefully to confirm whether it really lacks the toxin A gene or has a partially deleted toxin A gene that is not detected with commercial kits, as shown here [4].…”

Nosocomial infections and their control strategies

“…It is anaerobic and spore-forming bacteria. It usually colonizes in intestinal tract and serves as part of normal microbiota [24]. Diseases caused by toxins produced by C. difficile are colitis and it is responsible for 15%-25% cases of diarrhea.…”