Abstract
BackgroundClostridium difficile infection (CDI) is an emerging healthcare problem in the world. The purpose of this study was to perform a systematic epidemiological research of CDI in Tongji hospital, the central of China.MethodsStool samples from hospitalized adults suspected of CDI were enrolled. The diagnosis of CDI were based on the combination of clinical symptoms and laboratory results. Clinical features of CDI and non-CDI patients were compared by appropriate statistical tests to determine the risk factors of CDI. Multilocus sequence typing (MLST) was employed for molecular epidemiological analysis. Susceptibility testing and relevant antimicrobial agent resistance genes were performed as well.ResultsFrom June 2016 to September 2017, 839 hospitalized adults were enrolled. Among them, 107 (12.8%, 107/839) patients were C. difficile culture positive, and 73 (8.7%, 73/839) were infected with toxigenic C. difficile (TCD), with tcdA + tcdB+ strains accounting for 90.4% (66/73) and tcdA-tcdB+ for 9.6% (7/73). Meanwhile, two TCD strains were binary toxin positive and one of them was finally identified as CD027. Severe symptoms were observed in these two cases. Multivariate analysis indicated antibiotic exposure (p = 0.001, OR = 5.035) and kidney disease (p = 0.015, OR = 8.329) significantly increased the risk of CDI. Phylogenetic tree analysis demonstrated 21 different STs, including one new ST (ST467); and the most dominant type was ST54 (35.6%, 26/73). Multidrug-resistant (MDR) TCD were 53.4% (39/73); resistance to ciprofloxacin, erythromycin, and clindamycin were > 50%. Other antibiotics showed relative efficiency and all strains were susceptible to metronidazole and vancomycin. All moxifloxacin-resistant isolates carried a mutation in GyrA (Thr82 → Ile), with one both having mutation in GyrB (Ser366 → Ala).ConclusionsKnowledge of epidemiological information for CDI is limited in China. Our finding indicated tcdA + tcdB+ C. difficile strains were the dominant for CDI in our hospital. Significant risk factors for CDI in our setting appeared to be antibiotic exposure and kidney disease. Metronidazole and vancomycin were still effective for CDI. Although no outbreak was observed, the first isolation of CD027 in center China implied the potential spread of this hypervirulent clone. Further studies are needed to enhance our understanding of the epidemiology of CDI in China.
Highlights
Clostridium difficile infection (CDI) is an emerging healthcare problem in the world
CDI diagnosis was based on the combination of clinical symptoms and laboratory results, which was defined as the presence of diarrhea and a stool test that was positive for the toxigenic C. difficile (TCD) (Xpert C. difficile assay) or clinical evidence of pseudomembranous colitis [7]
The epidemiological associations of CDI were divided into two types: 1) healthcare facility-associated (HCFA), the symptoms developed after 48 h of admission or within 12 weeks after discharge from a healthcare facility; 2) CA, the symptoms developed before 48 h of admission and had not been admitted to a healthcare facility in the previous 12 weeks [18]
Summary
Clostridium difficile infection (CDI) is an emerging healthcare problem in the world. The purpose of this study was to perform a systematic epidemiological research of CDI in Tongji hospital, the central of China. Clostridium difficile infection (CDI), which is caused by toxigenic C. difficile (TCD), has been linked to healthcare facility-associated (HCFA) diarrhea since 1977 [1]. Published data suggest a decline in CDI incidence in hospitalized patients after 2009, but the number of cases remains high. Clinical practice guidelines of the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA) claim leukocytosis and increased serum creatinine levels are able to reflect the severity of CDI [7]. Results of a previous study which analyzed 70 patients (> 80 years) with CDI indicated that higher white blood cell counts were independently associated with treatment failure [8]
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