Identification of<i>Clostridium difficile</i>Ribotype 027 for the First Time in Mainland China

Wang, Pu; Zhou, Youlian; Wang, Zhongqiu; Xie, Songqiang; Zhang, Ting; Lin, Minyi; Li, Runhua; Tan, Jiasheng; Chen, Ye; Jiang, Bo

doi:10.1086/674405

Cited by 37 publications

(24 citation statements)

References 11 publications

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“…Of note, ST1 (PCR ribotype 027), a hypervirulent type widely distributed in Europe and North America, and ST11 (ribotype 078), a type associated with community-acquired CDI commonly found in Europe, were not detected in this study. In China, only one strain of ribotype 027 and one strain of ribotype of 078 have been reported up to now [20], [21].…”

Section: Results Discussion and Conclusionmentioning

confidence: 99%

ICU-Onset Clostridium difficile Infection in a University Hospital in China: A Prospective Cohort Study

Wang

Cai

et al. 2014

PLoS ONE

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A prospective study was conducted to investigate the incidence, clinical profiles and outcome of ICU-onset CDI in a 50-bed medical ICU at a university hospital in China. Stools were collected from patients who developed ICU-onset diarrhea and was screened for tcdA (toxin A gene) and tcdB (toxin B gene) by PCR. CDI cases were compared with the ICU-onset non-CDI diarrhea cases for demographics, comorbidities, potential risk factors, major laboratory findings and outcomes. Stool samples from CDI cases were subjected to C. difficile culture and C. difficile isolates were screened for tcdA, tcdB and the binary toxin genes (cdtA and cdtB) using multiplex PCR. Strain typing of toxigenic C. difficile isolates was performed using multilocus sequence typing. There were 1,277 patients in the ICU during the study period and 124 (9.7%) developed ICU-onset diarrhea, of which 31 patients had CDI. The incidence of ICU-onset CDI was 25.2 cases per 10,000 ICU days. ICU-onset CDI cases had similar features with ICU-onset non-CDI diarrhea cases including the use of proton pump inhibitors and antibacterial agents. The crude mortality rate of ICU-onset CDI was 22.6%, but the attributable mortality rate of ICU-onset CDI was only 3.2% here. Toxigenic C. difficile isolates were recovered from 28 out of the 31 patients with CDI. cdtA and cdtB were found in two strains. Seventeen STs including 11 new STs were identified. All of the 11 new STs were single-locus variants of known STs and the 17 STs identified here could be clustered into 3 clades. The incidence of ICU-onset CDI here is similar to those in Europe and North America, suggesting that CDI is likely to be a common problem in China. Toxigenic C. difficile here belonged to a variety of STs, which may represent a significant clonal expansion rather than the true clonal diversity.

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Section: Results Discussion and Conclusionmentioning

confidence: 99%

ICU-Onset Clostridium difficile Infection in a University Hospital in China: A Prospective Cohort Study

Wang

Cai

et al. 2014

PLoS ONE

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“…At University Hospital Huashan, ribotype 027 has not been recovered. However, in late 2013, Wang et al [30] reported the identification of a C. difficile ribotype 027 isolate in mainland China for the first time. Since this hypervirulent strain has spread rapidly in North America and Europe and is associated with many outbreaks, Chinese health workers must become highly vigilant.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics of Clostridium difficile infection in hospitalized patients with antibiotic-associated diarrhea in a university hospital in China

Zhou

Shi

Klena

et al. 2014

Eur J Clin Microbiol Infect Dis

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The purpose of this study was to identify clinical characteristics of Clostridium difficile infection (CDI) in patients with antibiotic-associated diarrhea (AAD). A prospective study was conducted among patients hospitalized in Fudan University Hospital Huashan from August 1, 2012 to July 31, 2013. Toxigenic C. difficile isolates were characterized by PCR ribotyping and multilocus sequence typing. AAD developed in 1.0 % (206/20437) of the antibiotic-treated hospitalized patients and toxigenic C. difficile was isolated from 30.6 % (63/206) of patients with AAD. The frequency of AAD was highest in the intensive care unit (10.7 %); however the proportion of CDI in AAD was highest in the Geriatric Unit (38 %). AAD ranged in severity from mild to moderate. One case with pseudomembranous colitis was identified. Use of carbapenems was found to significantly increase the risk of CDI (OR, 2.31; 95 % CI, 1.22–4.38; p= 0.011). Patient demographics, presumed risk factors, clinical manifestations and laboratory findings revealed no significant difference between patients with CDI and non-C. difficile AAD. Over 90 % of the patients with CDI or non-C. difficile AAD were cured. Two patients had CDI recurrence. Ribotype H was the dominant (18.8 %) genotype, followed by ribotype 012 and ribotype 017. C. difficile plays a significant role in AAD in our setting in China. Because the severity of diarrhea ranges from mild to moderate, it is difficult for Chinese clinicians to identify CDI from AAD patients, therefore CDI should be included in the routine differential diagnoses for hospitalized patients presenting with AAD.

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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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confidence: 99%

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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Identification ofClostridium difficileRibotype 027 for the First Time in Mainland China

Cited by 37 publications

References 11 publications

ICU-Onset Clostridium difficile Infection in a University Hospital in China: A Prospective Cohort Study

ICU-Onset Clostridium difficile Infection in a University Hospital in China: A Prospective Cohort Study

Clinical characteristics of Clostridium difficile infection in hospitalized patients with antibiotic-associated diarrhea in a university hospital in China

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

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