Rapid spread of <i>Clostridium difficile</i> NAP1/027/ST1 in Chile confirms the emergence of the epidemic strain in Latin America

Aguayo, Carolina; Flores, Roberto; Lévesque, Simon; Araya, Pamela; Ulloa, Soledad; Lagos, Jaime; Hormázabal, Juan Carlos; Tognarelli, Javier; Ibáñez, Daniel Barredo; Pidal, Paola; Duery, Oscar; Olivares, Bernardo David Olivares; Fernández, Jorge Onrubia

doi:10.1017/s0950268815000023

“…3 Reporting clinical outcomes provides an opportunity to assess the safety and potential benefits of reducing unnecessary antibiotic use. A few studies showed no change or a decrease in Clostridium difficile infection and antibiotic-resistant pathogens, which are important metrics for assessing the patient-level impact of antibiotic stewardship.…”

Section: Resultsmentioning

confidence: 99%

“…This epidemic strain was also reported in Asia, providing evidence of worldwide spread. 3 Patients infected with the 027 strain are 3 times more likely to have severe disease than those infected with non-027 strains. 4,5 This finding was linked to increased production of A, B, and binary toxins, in association with a mutation in the gene regulating of the expression of these toxins, leading to overproduction.…”

Section: Hypervirulent Clostridium Difficile Strain Has Arrived In Brmentioning

confidence: 99%

Hypervirulent Clostridium difficile Strain Has Arrived in Brazil

Pires

¹

,

Monteiro

²

,

Saldanha

³

et al. 2018

Infect. Control Hosp. Epidemiol.

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“…lostridium difficile is a leading cause of nosocomial antibioticassociated diarrhea in developed and developing countries (1,2,5). Antibiotic treatment results in disturbance of the natural gut microflora, allowing germination and outgrowth of C. difficile spores and proliferation and colonization of live cells (3).…”

mentioning

confidence: 99%

Ultrastructural Variability of the Exosporium Layer of Clostridium difficile Spores

Pizarro-Guajardo

¹

,

Calderón-Romero

²

,

Castro-Córdova

³

et al. 2016

Appl Environ Microbiol

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The anaerobic sporeformer Clostridium difficile is the leading cause of nosocomial antibiotic-associated diarrhea in developed and developing countries. The metabolically dormant spore form is considered the transmission, infectious, and persistent morphotype, and the outermost exosporium layer is likely to play a major role in spore-host interactions during the first contact of C. difficile spores with the host and for spore persistence during recurrent episodes of infection. Although some studies on the biology of the exosporium have been conducted ( , there is a lack of information on the ultrastructural variability and stability of this layer. In this work, using transmission electron micrographs, we analyzed the variability of the spore's outermost layers in various strains and found distinctive variability in the ultrastructural morphotype of the exosporium within and between strains. Through transmission electron micrographs, we observed that although this layer was stable during spore purification, it was partially lost after 6 months of storage at room temperature. These observations were confirmed by indirect immunofluorescence microscopy, where a significant decrease in the levels of two exosporium markers, the N-terminal domain of BclA1 and CdeC, was observed. It is also noteworthy that the presence of the exosporium marker CdeC on spores obtained from C. difficile biofilms depended on the biofilm culture conditions and the strain used. Collectively, these results provide information on the heterogeneity and stability of the exosporium surface of C. difficile spores. These findings have direct implications and should be considered in the development of novel methods to diagnose and/or remove C. difficile spores by using exosporium proteins as targets.

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“…nfections caused by Clostridium difficile are the leading cause of nosocomial antibiotic-associated diarrhea in developed and developing countries (1,2). Mortality rates of C. difficile infections (CDIs) may reach up to 5%; however, the recurrence of the infection, which may reach up to 25, 40, and 65% of cases after a first, second, and third episode of CDI, respectively, has become the current main clinical challenge (3).…”

mentioning

confidence: 99%

Ultrastructure Variability of the Exosporium Layer of Clostridium difficile Spores from Sporulating Cultures and Biofilms

Pizarro-Guajardo

¹

,

Calderón-Romero

²

,

Paredes-Sabja

³

2016

Appl Environ Microbiol

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The anaerobic sporeformer Clostridium difficile is the leading cause of nosocomial antibiotic-associated diarrhea in developed and developing countries. The metabolically dormant spore form is considered the morphotype responsible for transmission, infection, and persistence, and the outermost exosporium layer is likely to play a major role in spore-host interactions during recurrent infections, contributing to the persistence of the spore in the host. A recent study (M. Pizarro-Guajardo, P. Calderón-Romero, P. Castro-Córdova, P. Mora-Uribe, and D. Paredes-Sabja, Appl Environ Microbiol 82:2202-2209, 2016, http://dx.doi .org/10.1128/AEM.03410-15) demonstrated by transmission electron microscopy the presence of two ultrastructural morphotypes of the exosporium layer in spores formed from the same sporulating culture. However, whether these distinct morphotypes appeared due to purification techniques and whether they appeared during biofilm development remain unclear. In this communication, we demonstrate through transmission electron microscopy that these two exosporium morphotypes are formed under sporulation conditions and are also present in spores formed during biofilm development. In summary, this work provides definitive evidence that in a population of sporulating cells, spores with a thick outermost exosporium layer and spores with a thin outermost exosporium layer are formed. IMPORTANCEClostridium difficile spores are recognized as the morphotype of persistence and transmission of C. difficile infections. Spores of C. difficile are intrinsically resistant to all known antibiotic therapies. Development of spore-based removal strategies requires a detailed knowledge of the spore surface for proper antigen selection. In this context, in this work we provide definitive evidence that two types of spores, those with a thick outermost exosporium layer and those with a thin outermost exosporium layer, are formed in the same C. difficile sporulating culture or during biofilm development. Infections caused by Clostridium difficile are the leading cause of nosocomial antibiotic-associated diarrhea in developed and developing countries (1, 2). Mortality rates of C. difficile infections (CDIs) may reach up to 5%; however, the recurrence of the infection, which may reach up to 25, 40, and 65% of cases after a first, second, and third episode of CDI, respectively, has become the current main clinical challenge (3). The main factors in recurrence of CDI include (i) an irreversible loss of function of the gut microbiota due to antibiotic therapy, leading to a loss of the colonization resistance barrier against enteric pathogens (4, 5), and (ii) the formation of metabolically dormant spores during the course of infection (6, 7). These newly formed C. difficile spores have been shown to be essential for the transmission of the disease to a new susceptible host and for the persistence of C. difficile in the host, leading to recurrent infection (6).Biofilms are sessile surface-associated microbial communities that rep...

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Rapid spread of Clostridium difficile NAP1/027/ST1 in Chile confirms the emergence of the epidemic strain in Latin America

Cited by 32 publications

References 14 publications

Hypervirulent Clostridium difficile Strain Has Arrived in Brazil

Hypervirulent Clostridium difficile Strain Has Arrived in Brazil

Ultrastructural Variability of the Exosporium Layer of Clostridium difficile Spores

Ultrastructure Variability of the Exosporium Layer of Clostridium difficile Spores from Sporulating Cultures and Biofilms

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