Molecular epidemiology of Clostridium difficile in two tertiary care hospitals in Shandong Province, China

• Published in: Infection and drug resistance Vol. 11; pp. 489 - 500
• Main Authors: Luo, Ying, Zhang, Wen, Cheng, Jing-Wei, Xiao, Meng, Sun, Gui-Rong, Guo, Cheng-Jie, Liu, Ming-Jun, Cong, Pei-Shan, Kudinha, Timothy
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.01.2018; Taylor & Francis Ltd; Dove Medical Press
• Subjects: Algorithms; Antibacterial agents; Antimicrobial agents; Care and treatment; Ciprofloxacin; Clindamycin; Clostridium difficile; Clostridium infections; Dehydrogenases; Deoxyribonucleic acid; Diagnosis; Diarrhea; DNA; Drug resistance; Epidemiology; Erythromycin; Genes; Genomics; Genotypes; Glutamate; Glutamate dehydrogenase; Hospitalization; Infection; Infections; Inflammatory bowel disease; Laboratories; Metronidazole; Microbial drug resistance; Molecular diagnostic techniques; Multilocus sequence typing; Original Research; Patients; Polymerase chain reaction; Ribotyping; Strains (organisms); Studies; Technology application; Tetracyclines; China; Beijing China; Australia; North America; Europe; severity score; Shandong Province; antimicrobial resistance; China; Clostridium difficile; genotype
• ISSN: 1178-6973; 1178-6973
• DOI: 10.2147/idr.s152724

The incidence and severity of infection (CDI) have markedly increased over the past decade. However, there is very limited epidemiological data on CDI in China so far, specifically no data in Shandong Province. The aim of this study was to evaluate diagnostic algorithm for CDI and to gain data on molecular epidemiology of CDI in the Shandong Province of China. Nonrepetitive unformed fecal specimens (n=504) were investigated by the glutamate dehydrogenase (GDH), toxin A&B (CDAB) tests and toxigenic culture. Furthermore, 85 isolates were characterized by toxin gene detection, multilocus sequence typing, ribotyping and antimicrobial susceptibility testing. The algorithm of combining GDH and CDAB tests could define diagnosis of 54.2% CDI cases and excluded 90% of non-CDI. Further adding the toxigenic culture to the algorithm enhanced the detection sensitivity to 100%. Toxigenic strains comprised 84.7% of isolates, including A+B+CDT- (71.8%, 61/85), A-B+CDT- (11.8%, 10/85) and A+B+CDT+ (1.2%, 1/85) isolates. RT046/ST35 (13.9%, 10/72), RT014/ST2 (12.5%, 9/72) and RT017/ST37 (12.5%, 9/72) were the more common genotypes among toxigenic strains. The clinical severity score of A-B+CDT- toxin genes genotype (3.50±0.85) was significantly higher than the A+B+CDT- type (2.59±0.93) ( <0.05). RT046/ST35 isolates were highly prevalent and had high clinical severity scores (3.80±0.92). Variations in resistance from different sequence types (STs) were observed. Toxigenic strains showed higher resistance rates to erythromycin, clindamycin and ciprofloxacin compared to nontoxigenic strains ( <0.05). The epidemiology of in Shandong Province differed from other regions in China. Comprehensive optimized diagnosis strategy and continuous surveillance should be established and applied in order to curb the spread of toxigenic strains, especially for hospitalized patients.