First molecular characterisation and PCR ribotyping of Clostridium difficile strains isolated in two Algerian Hospitals

Abstract

Introduction: Clostridium difficile is the major etiological agent of nosocomial antibiotics associated diarrhoea. C. difficile infection is associated with considerable morbidity and mortality among hospitalized patients worldwide. Despite its known importance, there is no study on this important pathogen in Algeria. Methodology: In this prospective study, undertaken between 2013 and 2015, faecal specimens were collected from 159 hospitalized patients with antibiotic-associated diarrhoea in two tertiary health care hospitals in Chlef, Algeria. Faecal samples were cultured on CLO plates Agar with cefoxitin, cycloserine antibiotics and sodium taurocholate. C. difficile suspected colonies were analysed by multiplex PCR for the detection of the toxin genes. C. difficile isolates were analysed by PCR ribotyping and multi-locus tandem repeat analysis. Antimicrobial susceptibility was determined by the E-test method, according to the Clinical and Laboratory Standards Institute protocol. Results: C. difficile was cultured from 11 of 159 stool specimen (6.9%). Seven strains were toxigenic, mainly represented by the 020 and 014 PCR ribotypes and four non toxigenic belong to PCR ribotype 084. All 11 isolates were susceptible to both vancomycin and metronidazole and resistant to ciprofloxacin. Conclusions: This study, which reported for the first time C. difficile ribotypes circulating in Algerian health care facilities, could paves the way for further more comprehensive studies on this important pathogen, and could be useful to the local health authorities to implement a surveillance program of C. difficile in Algeria.

Clostridioides difficile ribotypes 001 and 126 were predominant in Tehran healthcare settings from 2004 to 2018: a 14-year-long cross-sectional study

“…However, in the isolates from Ghana (40%, n = 6/15) and Algeria (36.4%, n = 4/11) in Africa, RT 084 was the most prevalent and with an equal distribution between symptomatic patients and asymptomatic controls. In addition, all were found to be nontoxigenic and resistant to erythromycin and ciprofloxacin [45][46][47]. When comparing the age groups, the overall ribotype diversity was higher in patients aged ≥81 years which is consistent with the results from a multicentre study performed in Europe [48].…”

“…Surprisingly, several RTs identified in our study carried toxin genes (RTs 031, 038, 039, 084, 085) but in other studies an absence of the toxin genes in these ribotypes was identified [28,[45][46][47][48][49][50][51]. The differences in PaLoc arrangements in certain RTs were also noted previously.…”

Clostridium difficile shedding by healthy dogs in Nigeria and Malawi

“…There was minimal overlap in types between regions, with only ribotype 084 being found in both locations. This strain has also be reported in humans and animals in different countries, including Africa (Djebbar et al, ; Janezic, Ocepek, Zidaric, & Rupnik, ). This non‐toxigenic ribotype was the 2nd most common strain in Nigerian dogs and was the predominant type in two studies of humans in Ghana, another West African country (Janssen et al, ; Seugendo et al, ).…”

Clostridium difficile — from Bacillus difficilis to Clostridioides difficile, global molecular epidemiology and possible implications for the Russian Federation

“…A small study from Ghana revealed only three toxigenic isolates out of a total of fi ft een [99]. Th e most frequent (non-toxigenic) RT was RT084 as seen in the Algerian study [97]. In another study conducted in Tanzania only seven isolates could be retrieved including three RT038, two RT045 and two unknown RTs [100].…”

“…In Algeria one study has been published so far including only 11 isolates of which four were non-toxigenic (RT084) and the other seven strains included mainly RT014 and RT020 [97]. In South Africa for instance in a small study including 32 isolates RT017 was most prevalent (50%) while 16% of all isolates were RT001 [98].…”