High Prevalence of Clostridioides difficile Ribotype 176 in the University Hospital in Kosice

Abstract

Dysbiosis of the gut microbiota, caused by antibiotics, plays a key role in the establishment of Clostridioides difficile CD). Toxin-producing strains are involved in the pathogenesis of Clostridioides difficile infection (CDI), one of the most common hospital-acquired infections. We cultured a total of 84 C. difficile isolates from stool samples of patients hospitalized at Louis Pasteur University Hospital in Kosice, Slovakia, that were suspected of CDI and further characterized by molecular methods. The presence of genes encoding toxin A, toxin B, and binary toxin was assessed by toxin-specific PCR. CD ribotypes were detected using capillary-based electrophoresis ribotyping. A total of 96.4% of CD isolates carried genes encoding toxins A and B, and 54.8% of them were positive for the binary toxin. PCR ribotyping showed the presence of three major ribotypes: RT 176 (n = 40, 47.6%); RT 001 (n = 23, 27.4%); and RT 014 (n = 7, 8.3%). Ribotype 176 predominated among clinical CD isolates in our hospital. The proportion of RT 176 and RT 001 in four hospital departments with the highest incidence of CDI cases was very specific, pointing to local CDI outbreaks. Based on our data, previous use of antibiotics represents a significant risk factor for the development of CDI in patients over 65 years of age.

Usefulness of Capillary Gel Electrophoresis-Based PCR for Detection of Clostridioides difficile Strains with Hypervirulent Ribotypes

“…Capillary electrophoresis offers an improved separation of amplified nucleic acid fragments, leading to enhanced sensitivity of the assay compared to traditional agarose electrophoresis [52,55,56]. Therefore, it may lead to relatively fast recognition of CDI hospital outbreaks worldwide [57][58][59] and facilitate antimicrobial resistant strains' elimination [60][61][62][63], including those derived from children [64], the environment, plants and animals [65][66][67][68][69][70][71]. As it has been previously proven, an ineffective decontamination with non-optimal time of exposure or a concentration of sporicidal disinfectants may result in an extensive C. difficile strain transmission [60].…”

Clostridioides difficile from Fecally Contaminated Environmental Sources: Resistance and Genetic Relatedness from a Molecular Epidemiological Perspective

“…For instance, nosocomial CDI is often associated with "hypervirulent" RT027, which has been frequently found in hospital settings and outbreaks, especially in Europe, North America and to some extent in Asian countries [9][10][11]. Furthermore, other "hypervirulent" RTs, such as RT023, RT078, RT126, RT127, and RT176, are known [12][13][14][15]. Of note, RT078 is more commonly associated with community associated (CA)-CDI.…”