Molecular epidemiologic study of Clostridium difficile infections in university hospitals: Results of a nationwide study in Japan |
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Authors: | Issei Tokimatsu Katsumi Shigemura Kayo Osawa Shinya Kinugawa Koichi Kitagawa Noriko Nakanishi Hiroyuki Yoshida Soichi Arakawa Masato Fujisawa |
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Affiliation: | 1. Department of Infection Prevention and Control, Kobe University Hospital, Kobe, Japan;2. Division of Infectious Diseases, Department of International Health, Kobe University Graduate School of Health Sciences, Kobe, Japan;3. Division of Urology, Department of Organ Therapeutics, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan;4. Division of Biophysics, Kobe University Graduate School of Health Science, Kobe, Japan;5. Division of Translational Research for Biologics, Department of Internal Medicine Related, Kobe University Graduate School of Medicine, Kobe, Japan;6. Department of Infectious Diseases, Kobe Institute of Health, Kobe, Japan;g. Hyogo Clinical Laboratory Corporation, Himeji, Hyogo, Japan;h. Department of Urology, Sanda City Hospital, Sanda, Hyogo, Japan |
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Abstract: | We conducted a nationwide molecular epidemiological study of Clostridium difficile infection (CDI) in Japan investigated the correlation between the presence of binary toxin genes and CDI severity. This is the first report on molecular epidemiological analyses for CDI in multiple university hospitals in Japan, to our knowledge. We examined 124,484 hospitalized patients in 25 national and public university hospitals in Japan between December 2013 and March 2014, investigating antimicrobial susceptibilities and toxin-related genes for C. difficile isolates from stools. Epidemiological genetic typing was performed by PCR-ribotyping and repetitive sequence-based (rep)-PCR to examine the genetic similarities. The results detected toxin A-positive, toxin B-positive, binary toxin-negative (A+B+CDT?) detected from 135 isolates (80.8%) and toxin A-negative, toxin B-positive, binary toxin-negative (A??B+CDT?) in 23 (13.8%). Toxin A-positive, toxin B-positive, and binary toxin-positive (A+B+CDT+) were seen in 9 isolates (5.4%). Vancomycin (n = 81, 37.7%) or metronidazole (n = 88, 40.9%) therapies were undertaken in analyzed cases. Ribotypes detected from isolates were 017/subgroup 1, 070, 078, 126, 176, 449, 475/subgroup 1, 499, 451, 566 and newtypes. Rep-PCR classified 167 isolates into 28 cluster groups including 2–15 isolates. In addition, 2 pairs of strains isolated from different institutions belonged to the same clusters. Seven out of 9 (77.8%) of the patients with binary toxin producing strains had “mild to moderate” outcome in evaluated symptoms. In conclusion, we found that binary toxin did not show regional specificity and had no relevance to severity of CDI. |
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Keywords: | Nationwide study Epidemiology Cluster analysis |
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