Abstract
ABSTRACT Molecular epidemiology of Clostridium difficile infection (CDI) has been extensively studied in North America and Europe; however, limited data on CDI are available in the Asia-Pacific region. A multicentre retrospective study was conducted in this region. C. difficile isolates were subjected to multilocus sequence typing (ST) and antimicrobial susceptibility testing. Totally, 394 isolates were collected from Hangzhou, Hong Kong, China; Busan, South Korea; Fukuoka, Japan; Singapore; Perth, Sydney, Australia; New York, the United States. C. difficile isolates included 337 toxin A-positive/B-positive/binary toxin-negative (A+B+CDT-), 48 A-B+CDT-, and nine A+B+CDT+. Distribution of dominant STs varied geographically with ST17 in Fukuoka (18.6%), Busan (56.0%), ST2 in Sydney (20.4%), Perth (25.8%). The antimicrobial resistance patterns were significantly different among the eight sites (χ 2 = 325.64, p < 0.001). Five major clonal complexes correlated with unique antimicrobial resistances. Healthcare-associated (HA) CDI was mainly from older patients with more frequent antimicrobial use and higher A-B+ positive rates. Higher resistance to gatifloxacin, tetracycline, and erythromycin were observed in HA-CDI patients (χ 2 = 4.76-7.89, p = 0.005-0.029). In conclusion, multiple C. difficile genotypes with varied antimicrobial resistance patterns have been circulating in the Asia-Pacific region. A-B+ isolates from older patients with prior antimicrobial use were correlated with HA-CDI.
Highlights
Clostridium difficile is a Gram-positive ubiquitous endospore-forming anaerobic bacterium that is a leading cause of antimicrobial-associated diarrhea and colitis [1]
The following parameters were found to be significantly correlated with the presence of C. difficile infection (CDI) among all six sites: age, CDI type, fever higher than 38.3°C, neutrophils over 70%, serum albumin less than 35 g/L, creatinine more than 111 μM, and antimicrobial use within the prior 8 weeks (Table 1)
No significant differences were found in white blood cells (WBCs), and the proportion of WBCs of more than 10 at all sites was less than 50%
Summary
Clostridium difficile is a Gram-positive ubiquitous endospore-forming anaerobic bacterium that is a leading cause of antimicrobial-associated diarrhea and colitis [1]. C. difficile infection (CDI) is a toxin-mediated disease, with clinical presentations ranging from mild self-limiting diarrhea to life-threatening pseudomembranous colitis, toxic megacolon, bowel perforation and sepsis [2]. *This study was presented in part at the 16th Asia Pacific Congress of Clinical Microbiology & Infection, Melbourne, Australia, 30 November to 3 December. This article has been republished with minor changes. These changes do not impact the academic content of the article
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