Multilocus sequence typing (MLST) analysis of 104<i>Clostridium difficile</i>strains isolated from China

Yan, Qing Song; Zhang, J.; Chen, C.; Zhou, Haijian; Du, Pengcheng; Cui, Zhigang; Cen, R.; Liu, L.; Li, W.; Cao, Bo; Lu, Jinxing; Cheng, Ying

doi:10.1017/s0950268812000453

Cited by 45 publications

(42 citation statements)

References 13 publications

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“…Yet, our previous study demonstrated significant genetic diversity in tcdA and tcdB, consistent with the results of toxinotyping based on the restriction fragment length polymorphism (RFLP)-PCR method (19,28). However, the simple classification of RFLP-PCR failed to explain more details about the epidemiological relevance and phylogenetic relationships between strains with different types of toxin genes, while the recently increased ST37 (RT017 [A Ϫ B ϩ ]) contribution (48%) for CDI cases and its epidemic potentiality in Asia (11,16) make it urgent to build a more finely described pattern to reveal the intrinsic epidemic characteristics. In the present study, we introduce a novel approach that is more discerning and accurate; for example, 13 ST35 and 11 ST2 strains were divided into 2 groups (A03B04 and A02B05 and A06B07 and A09B06, respectively).…”

Section: Discussionsupporting

confidence: 71%

“…All 70 strains were characterized by the MLST method with seven housekeeping genes (21), and sequences were submitted to the Clostridium difficile multilocus sequence typing (MLST) database (http://pubmlst.org /cdifficile) to acquire a sequence type (ST). Thirty-five strains were part of the 104 strains used in our previous MLST study (16). A minimum spanning tree was also constructed to exhibit the population structure of Chinese strains using the categorical data for MLST via BioNumerics v4.0 software (Applied Maths BVBA, Belgium).…”

Section: Methodsmentioning

confidence: 99%

“…Recently, a particular variant strain of C. difficile, ST37, which has been ribotyped as RT017 and produces toxin B only, has attracted increasing attention (11,12,16). This type of strain shows increased resistance to clindamycin and erythromycin, with concomitant greater risk to inpatient health (13,17,18).…”

mentioning

confidence: 99%

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Sequence Variation in tcdA and tcdB of Clostridium difficile: ST37 with Truncated tcdA Is a Potential Epidemic Strain in China

Cao

Wang

et al. 2014

J Clin Microbiol

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Clostridium difficile is a well-known nosocomial infectious pathogen. Research on C. difficile infection has primarily focused on strains such as the hypervirulent PCR ribotype 027 (sequence type 1 [ST1]) emerging in Europe and North America. However, other new emerging ribotypes in some countries have attracted attention, such as PCR ribotype 17 (ST37) in Asia and Latin America. We collected 70 strains and sequenced their toxin genes, tcdA and tcdB. Multilocus sequence typing (MLST) was used to study their population structure. In addition, tcdA and/or tcdB sequences of 25 other isolates were obtained from GenBank. Single nucleotide polymorphisms (SNPs) were identified and analyzed. Phylogenetic analyses were performed to study toxin gene evolution. All tcdA and tcdB sequences were divided into 1 of 16 types (denoted A01 to -16 and B01 to -16, respectively). Hypervirulent strain RT027 is A13B12, and RT078 is A14B10, whereas the newly epidemic strain RT017 is A15B13. SNP analysis suggests the possibility of recombination in tcdB, perhaps through horizontal gene transfer. SNPs were also found in the sequences corresponding to the PCR primers widely used for toxin detection. Our study shows that ST037 shares a few genotypic features in its tcdA and tcdB genes with some known hypervirulent strains, indicating that they fall into a unique clade. Our findings can be used to map the relationships among C. difficile strains more finely than can be done with less sensitive methods, such as toxinotyping or even MLST, to reveal their inherent epidemiological characteristics.

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Section: Discussionsupporting

confidence: 71%

Section: Methodsmentioning

confidence: 99%

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Sequence Variation in tcdA and tcdB of Clostridium difficile: ST37 with Truncated tcdA Is a Potential Epidemic Strain in China

Cao

Wang

et al. 2014

J Clin Microbiol

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“…1 (7). Recently, multilocus sequence type (MLST) data have been published on isolates largely from Beijing, for which the dominant MLST type was found to be ST37, which the authors stated was representative of ribotype 017 (10). In contrast to mainland China, in Hong Kong C. difficile has been recognized for some time, the earliest report being from 1991 to 1993 in bone marrow transplant patients (11).…”

mentioning

confidence: 99%

Molecular Epidemiology of Clostridium difficile Infection in a Major Chinese Hospital: an Underrecognized Problem in Asia?

et al. 2013

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Clostridium difficile infection is almost unrecognized in mainland China. We have undertaken a study in a large Chinese teaching hospital in Changsha, Hunan, China, to identify cases of C. difficile, record patient characteristics, and define the molecular epidemiology with respect to ribotype distribution and cross-infection. Between April 2009 and February 2010, we examined fecal samples from 70 hospitalized patients with diarrhea who were receiving or had received antibiotics within the previous 6 weeks. Clinical information was collected and the samples were cultured for C. difficile retrospectively. Isolates were ribotyped, and multiple-locus variable-number tandem-repeat assay (MLVA) subtyping was performed on clusters of the same ribotype. The mean age of patients from whom C. difficile was cultured was 58 years, with only 4/21 patients aged >65 years. All patients, with a single exception, had received a third-generation cephalosporin and/or a quinolone antibiotic. Twenty-one isolates of C. difficile were recovered, and seven different ribotypes were identified, the dominant types being 017 (48%), 046 (14%), and 012 (14%). We identified two clusters of cross-infection with indistinguishable isolates of ribotype 017, with evidence of spread both within and between wards. We have identified C. difficile as a possibly significant problem, with cross-infection and a distinct ribotype distribution, in a large Chinese hospital. C. difficile may be underrecognized in China, and further epidemiological studies across the country together with the introduction of routine diagnostic testing are needed to ascertain the size of this potentially significant problem.

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“…Previous studies have reported ST-54, ST-35, and ST-37 as the top 3 prevalent genotypes in China (18). In addition, Zhou et al found ST-54 and ST-37 to be the prevalent genotypes in the Chinese city of Shanghai10.…”

Section: Discussionmentioning

confidence: 97%

Epidemiology of Clostridium difficile in a County Level Hospital in China

Yan¹,

Liang²,

Lv³

et al. 2017

Jundishapur J Microbiol

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Background: The incidence of Clostridium difficile infection (CDI) has markedly increased over the past decade. Although its epidemiology has been previously investigated in tertiary hospitals, no studies have investigated the prevalence of CDI in county level hospitals in China. Objectives: This study aimed at describing the molecular characteristics of toxigenic C. difficile isolated from a community level hospital and evaluating physicians' knowledge on CDI. Methods: We conducted a 15-month study at a country level hospital to characterize clinical isolates of C. difficile. A total of 61 toxigenic strains were isolated including 54 strains (88.5%), with both tcdA and tcdB genes positive and the remaining positive for the tcdB gene alone. Results: No binary toxin was detected. The toxigenic strains were found to be susceptible to vancomycin and metronidazole and exhibited high levels of resistance to clindamycin, levofloxacin, erythromycin, and ciprofloxacin. The most toxigenic C. difficile isolate was obtained from the gastroenterology and infection ward. Additionally, 13 sequence types (STs) were identified; ST-54 (32.8%), , , and ST-37 (11.5%) were the most common types. Conclusions:The results of the present study indicate that CDI may be a common problem, and large-scale multicenter studies are required to reveal the actual extent of the burden of CDI in county level hospitals.

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Multilocus sequence typing (MLST) analysis of 104Clostridium difficilestrains isolated from China

Cited by 45 publications

References 13 publications

Sequence Variation in tcdA and tcdB of Clostridium difficile: ST37 with Truncated tcdA Is a Potential Epidemic Strain in China

Sequence Variation in tcdA and tcdB of Clostridium difficile: ST37 with Truncated tcdA Is a Potential Epidemic Strain in China

Molecular Epidemiology of Clostridium difficile Infection in a Major Chinese Hospital: an Underrecognized Problem in Asia?

Epidemiology of Clostridium difficile in a County Level Hospital in China

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