The tcdA-negative and tcdB-positive Clostridium difficile ST81 clone exhibits a high level of resistance to fluoroquinolones: a multi-centre study in Beijing, China

Cheng, Jing; Liu, Chang; Kudinha, Timothy; Xiao, Meng; Fan, Xin; Yang, Cheng; Wei, Ming; Liang, Guo Wei; Shao, Dong Hua; Zhu, Xiong; Hou, Xianming; Song, Yu; Wang, Yao; Yang, Qi; Su, Jun-Ji; Xü, Ying

doi:10.1016/j.ijantimicag.2020.105981

Cited by 11 publications

(8 citation statements)

References 24 publications

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“…Unlike the previously reported predominant clones of C. difficile isolates elsewhere in China, which were ST37, followed by ST54, ST3, ST2, and ST35 (Huang et al, 2009;Hawkey et al, 2013;Luo et al, 2019), we observed that ST81 was the major ST type in Renji Hospital in Shanghai, China for these 5 years, indicating a geographical diversity of molecular typing. Notably, a growing trend of ST81 clone in Beijing has been reported recently (Cheng et al, 2020), while another study on C. difficile colonization in patients admitted to an intensive care unit in Shanghai demonstrated a predominant role of ST81 genotype (Cui et al, 2019). Given that ST81 strain is becoming epidemic while relevant data is limited, it is of great importance to analyze the risk factors and clinical outcome of ST81 clone infection, as well as to monitor the antimicrobial susceptibility patterns since ST81 has a higher resistance rate to fluroquinolones and clindamycin as previously discovered (Wang et al, 2018b) and has also been demonstrated by this study.…”

Section: Discussionmentioning

confidence: 99%

“…We found that the resistance rate to moxifloxacin in this study remained stable in these years (43.29%), while ST81 showed significantly higher resistance rate and MIC 50 than all the other STs. A multi-center study in Beijing, China has revealed that amino acid mutations in the gyrA and gyrB genes primarily underlies the resistance mechanism of fluoroquinolones (Cheng et al, 2020). Our study additionally compared demographics, underlying diseases, and therapeutic process during hospitalization and usage of medication between ST81 CDI and the two control groups by univariate regression model and then included the variables significantly different (p<0.05) between the case and control groups in a multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Molecular Epidemiology and Risk Factors of Clostridium difficile ST81 Infection in a Teaching Hospital in Eastern China

Yang

Huang

Qin

et al. 2020

Front. Cell. Infect. Microbiol.

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BackgroundThe prevalence of Clostridium difficile causes an increased morbidity and mortality of inpatients, especially in Europe and North America, while data on C. difficile infection (CDI) are limited in China.MethodsFrom September 2014 to August 2019, 562 C. difficile isolates were collected from patients and screened for toxin genes. Multilocus sequence typing (MLST) and antimicrobial susceptibility tests by E-test and agar dilution method were performed. A case group composed of patients infected with sequence type (ST) 81 C. difficile was compared to the non-ST81 infection group and non CDI diarrhea patients for risk factor and outcome analyses.ResultsThe incidence of inpatients with CDI was 7.06 cases per 10,000 patient-days. Of the 562 C. difficile isolates, ST81(22.78%) was the predominant clone over this period, followed by ST54 (11.21%), ST3 (9.61%), and ST2 (8.72%). Toxin genotype tcdA+tcdB+cdt- accounted for 50.18% of all strains, while 29.54% were tcdA-tcdB+cdt- genotypes. Overall, no isolate was resistant to vancomycin, teicoplanin or daptomycin, and resistance rates to meropenem gradually decreased during these years. Although several metronidazole-resistant strains were isolated in this study, the MIC values decreased during this period. Resistance rates to moxifloxacin and clindamycin remained higher than those to the other antibiotics. Among CDI inpatients, longer hospitalization, usage of prednisolone, suffering from chronic kidney disease or connective tissue diseases and admission to emergency ward 2 or emergency ICU were significant risk factors for ST81 clone infection. All-cause mortality of these CDI patients was 4.92%(n=18), while the recurrent cases accounted for 5.74%(n=21). The 60-day mortality of ST81-CDI was significantly higher than non-ST81 infected group, while ST81 also accounted for most of the recurrent CDI cases.ConclusionThis study revealed the molecular epidemiology and risk factors for the dominant C. difficile ST81 genotype infection in eastern China. Continuous and stringent surveillance on the emerging ST81 genotype needs to be initiated.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Molecular Epidemiology and Risk Factors of Clostridium difficile ST81 Infection in a Teaching Hospital in Eastern China

Yang

Huang

Qin

et al. 2020

Front. Cell. Infect. Microbiol.

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“…In Asia, the tcdA – tcdB + C. difficile strain ribotype 017/ST37 was previously reported to be the most epidemic clone ( Tang et al, 2016 ; Imwattana et al, 2019 ). Recently, however, numerous studies have demonstrated that another tcdA – tcdB + strain, ST81, has emerged as the predominant clone in northern and eastern China ( Qin et al, 2017 ; Cui et al, 2019 ; Cheng et al, 2020 ; Yang et al, 2020 ). In accordance with this, in our follow-up monitoring, the prevalence of ST81 was found to be remarkably higher than that of ST37 compared with our previous findings at the same institution in Shanghai ( Dong et al, 2014b ).…”

Section: Discussionmentioning

confidence: 99%

“…A systematic review in 2016 demonstrated that ST37, a tcdA -negative and tcdB -positive (A – B + ) strain, was most prevalent in mainland China ( Tang et al, 2016 ). However, several recent studies in Beijing and Shanghai found that the epidemic clone had been replaced by another tcdA -negative and tcdB -positive strain, ST81 ( Qin et al, 2017 ; Cui et al, 2019 ; Cheng et al, 2020 ; Yang et al, 2020 ), which has caused multiple nosocomial outbreaks. Isolates of C. difficile have been classified into five distinct phylogenetic lineages ( Janezic and Rupnik, 2015 ) based on the MLST database, where ST81 and ST37 belong to clade 4 and mainly correspond to ribotype 017 ( Wu et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Complete Genome Sequencing and Comparative Phenotypic Analysis Reveal the Discrepancy Between Clostridioides difficile ST81 and ST37 Isolates

Chen

Wang

et al. 2021

Front. Microbiol.

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Toxin A-negative, toxin B-positive Clostridioides difficile strains, which primarily include the ST81 and ST37 genotypes, are predominant in C. difficile infections leading to antibiotic-associated diarrhea in China. Recently, ST81 has been reported as the most prevalent genotype rather than ST37, although the genetic and functional characteristics of the two genotypes remain ambiguous. In this study, we conducted comprehensive comparative analysis of these two genotypes through complete genome sequencing and phenotypic profiling. The whole genome sequencing revealed that the ST81 and ST37 isolates were closely related genetically with similar gene compositions, and high rate of the core genome shared. The integrative and conjugative elements identified in ST81 were similar to those in ST37, albeit with more diverse and insertion regions. By characterizing the phenotypes related to colonization or survival in the host, we found that the ST81 isolates exhibited robust colonization ability and survival both in vitro and in vivo, enhanced spore production, and slightly increased motility, which may be attributable to the discrepancy in non-synonymous single-nucleotide polymorphisms in the relevant functional genes. Furthermore, the ST81 isolates displayed a significantly higher rate of resistance to fluoroquinolones compared with the ST37 isolates (94.12% vs. 62.5%) and mostly carried the amino acid substitution Asp426Val in GyrB. In summary, the results of our study indicate that ST81 isolates exhibit enhanced ability to transmit between hosts and survive in harsh environments, providing key genetic insights for further epidemiological investigations and surveillance of C. difficile infection.

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Analysis of Clostridioides difficile Infection in Children with Diarrhea in Two Hospitals in Southern Brazil

Maestri,

Mesa,

Vasconcelos

et al. 2023

Curr Microbiol

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The tcdA-negative and tcdB-positive Clostridium difficile ST81 clone exhibits a high level of resistance to fluoroquinolones: a multi-centre study in Beijing, China

Cited by 11 publications

References 24 publications

Molecular Epidemiology and Risk Factors of Clostridium difficile ST81 Infection in a Teaching Hospital in Eastern China

Molecular Epidemiology and Risk Factors of Clostridium difficile ST81 Infection in a Teaching Hospital in Eastern China

Complete Genome Sequencing and Comparative Phenotypic Analysis Reveal the Discrepancy Between Clostridioides difficile ST81 and ST37 Isolates

Analysis of Clostridioides difficile Infection in Children with Diarrhea in Two Hospitals in Southern Brazil

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