The First Two Clostridium difficile Ribotype 027/ST1 Isolates Identified in Beijing, China–an Emerging Problem or a Neglected Threat?

• Published in: Scientific reports Vol. 6; no. 1; p. 18834
• Main Authors: Cheng, Jing-Wei, Xiao, Meng, Kudinha, Timothy, Xu, Zhi-Peng, Hou, Xin, Sun, Lin-Ying, Zhang, Li, Fan, Xin, Kong, Fanrong, Xu, Ying-Chun
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 07.01.2016; Nature Publishing Group
• Subjects: 38/77; 631/326/107; 692/699/255/1911; Anti-Bacterial Agents - pharmacology; Bacterial Toxins - genetics; Beijing; Clinical medicine; Clostridium difficile - genetics; Clostridium difficile - isolation & purification; Enterocolitis, Pseudomembranous - microbiology; Fluoroquinolones; Genes; Genomes; Hospitals; Humanities and Social Sciences; Humans; Medical laboratories; Medical records; Medical schools; Microbial Sensitivity Tests; multidisciplinary; Neglected Diseases - microbiology; Outpatient care facilities; Patients; Polymerase chain reaction; Ribotyping; Science; Surveillance; Virulence; Beijing China; China
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/srep18834

Clostridium difficile hyper-virulent ribotype 027 strain has become a significant concern globally, but has rarely been reported in Asian countries including China. Recently, a retrospective single-center study in Beijing, China, detected two ribotype 027 C. difficile isolates from two patients coming for outpatient visits in 2012 and 2013. We performed a systematic investigation of the two isolates (and patients). Both C. difficile isolates had the typical PCR ribotype 027 profile; were positive for tcdA , tcdB and binary toxin genes; belonged to multilocus sequence type 1 (ST1); had typical ribotype 027 deletions in the tcdC gene; and were highly-resistant to fluoroquinolones; but had a different MLVA profile and were not genetically related to any previously reported international ribotype 027 clones. A review of the patients’ medical records showed that neither received appropriate antimicrobial treatment and were lost to follow-up after outpatient visits. We propose that C. difficile infections caused by ribotype 027 are probably a neglected problem in China and the subsequent impact of unawareness of this problem is worrying. Appropriate testing assays and multi-center or national level surveillance for C. difficile infections and specifically for ribotype 027 should be introduced to provide essential data and guide future clinical practice.