Abstract
BackgroundClostridium difficile infection (CDI), especially hospital-acquired Clostridium difficile infection (HA-CDI), continues to be a public health problem and has aroused great concern worldwide for years. This study aimed to elucidate the clinical and epidemiological features of HA-CDI and the characteristics of C.difficile isolates in Chongqing, Southwest China.MethodsA case-control study was performed to identify the clinical incidence and risk factors of HA-CDI. C. difficile isolates were characterised by polymerase chain reaction (PCR) ribotyping, multilocus sequence typing (MLST), toxin gene detection and antimicrobial susceptibility testing.ResultsOf the 175 suspicious patients, a total of 122 patients with antibiotic-associated diarrhea (AAD) were included in the study; among them, 38 had HA-CDI. The incidence of AAD and HA-CDI was 0.58 and 0.18 per 1000 patient admissions, respectively. Chronic renal disease and cephalosporin use were independent risk factors for HA-CDI. Fifty-five strains were assigned into 16 sequence types (STs) and 15 ribotypes (RTs). ST2/RT449 (8, 14.5%) was the predominant genotype. Of the 38 toxigenic isolates, A + B + CDT- isolates accounted for most (34, 89.5%) and 1 A + B + CDT+ isolate emerged. No isolate was resistant to vancomycin, metronidazole or tigecycline, with A-B-CDT- being more resistant than A + B + CDT-.ConclusionsDifferent genotypes of C. difficile strains were witnessed in Chongqing, which hinted at the necessary surveillance of HA-CDI. Adequate awareness of patients at high risk of HA-CDI acquisition is advocated and cautious adoption of cephalosporins should be highlighted.
Highlights
Clostridium difficile infection (CDI), especially hospital-acquired Clostridium difficile infection (HA-CDI), continues to be a public health problem and has aroused great concern worldwide for years
Our study was initiated to investigate the impact of HA-CDI by identifying its prevalence, determine the risk factors for the acquisition of this dilemma in patients with antibiotic-associated diarrhea (AAD), reveal the mortality of HA-CDI in this teaching hospital and inquire into the molecular epidemiology and antimicrobial resistance of C.difficile isolates found in this study
Among the 122 AAD patients, C. difficile was isolated from the specimens of 55 respondents, and 38 (31.1%) were positive for toxigenic C. difficile culture and diagnosed with HA-CDI, yielding an incidence of 0.41 HA-CDI per 1000 antibiotic-treated patients and 0.18 HA-CDI per 1000 patient admissions
Summary
Clostridium difficile infection (CDI), especially hospital-acquired Clostridium difficile infection (HA-CDI), continues to be a public health problem and has aroused great concern worldwide for years. Increased incidence and severity of Clostridium difficile infection (CDI) have been witnessed in Europe and North America in recent decades [3, 4]. Few regional studies alarmed that the hyper-virulent C. difficile strain ST-1 (BI/NAP1/027), an epidemic strain in Europe and North America, has emerged in Chinese hospital settings, recent reports revealed that ST35, ST37 and ST3 were the most prevalent genotypes in mainland China [6, 7]. Our study was initiated to investigate the impact of HA-CDI by identifying its prevalence, determine the risk factors for the acquisition of this dilemma in patients with antibiotic-associated diarrhea (AAD), reveal the mortality of HA-CDI in this teaching hospital and inquire into the molecular epidemiology and antimicrobial resistance of C.difficile isolates found in this study
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