Abstract
The objective of this study was to analyse the genetic relatedness of Clostridioides difficile polymerase chain reaction ribotype 017 (RT017) strains from patients with hospital-acquired C. difficile infection (HA-CDI) in a hospital with a high RT017 prevalence. From 2009 to 2013, 200 RT017 strains (26.8%) were collected from 745 HA-CDI patient isolates. They comprised 64 MLVA types, and 197 (98.5%) strains were genetically related to 5 clonal complexes (CCs). The largest cluster, CC-A, included 163 isolates of 40 MLVA types. CC-A accounted for 20% of RT017 strains in 2009 and sharply increased to 94.9% in 2010, 94% in 2011, 86.2% in 2012, and 73.5% in 2013. The other 4 CCs included 20 isolates with 7 MLVA types. The resistance rates of antimicrobials were as follows: clindamycin 100%, moxifloxacin 99%, rifaximin 88.5%, and vancomycin 1%. All isolates were susceptible to metronidazole and piperacillin/tazobactam. Comparing antibiotic resistance among CCs, the geometric mean of the minimum inhibitory concentrations of moxifloxacin, vancomycin, and piperacillin/tazobactam were significantly higher for CC-A isolates than for the other CCs. RT017 clones constantly evolved over the 5 years studied with regard to genetic relatedness. The levels of antibiotic resistance may contribute to the persistence of organisms in the institution.
Highlights
Clostridioides difficile is a leading pathogen that frequently causes hospital infections
Outbreaks of C. difficile infections (CDIs) caused by ribotype 017 (RT017) have been frequently noted in many countries, and a high prevalence of RT017 strains has been reported in Argentina, South Africa, and Asian countries such as Korea and China [5,7,8,9,10]
ReOsuvletsr the 5-year period under study, 826 patients were diagnosed with hospital-acquired C. difficile infection (HA-CDI), 745 C. difOficvieler itshoela5t-eysewarepreercioudltiuvnadteedr fsrtuodmy,st8o2o6lpsaatmiepntlsesw, aenreddtoiaxginnoosteydpiwnigthanHdAP-CCDRIr, ibotypit7rsnhit4brge5aoiiwtCnsyos.ep.lrdaiAenitflgfieplsctewihloreeeffoiriRsseroomTpllaa0eett1reedf7sso. osrwAmfheRoetrTowed0t.cea1udl7Alosttihfovtooxa2wtit0ane0elddAoifsft-roono2xlme0aing0teasAisttso-io(nvo2leeal6gts.aea8asnt%midv(2)pet6lwaoe.n8xse%d,irnae)tonBwixdd-iepnetrooneBxst-iiiipdnftoiioeevsntdieyttiipvtafioiesenxdtgRionxTaaoisn0ntd1yoR7tpTPyes0pCst1erR7s(aSinusp.pAlel-l m(SeunptpalreymFenigtaurryeFSi1g)u.re S1)
Summary
Clostridioides difficile is a leading pathogen that frequently causes hospital infections. RT017 is among several clonal lineages of C. difficile known to cause parallel increases in disease severity, mortality, and recurrence [2,3], but has shown similar clinical outcomes to other lineages in some reports [4,5]. Outbreaks of C. difficile infections (CDIs) caused by RT017 have been frequently noted in many countries, and a high prevalence of RT017 strains has been reported in Argentina, South Africa, and Asian countries such as Korea and China (especially the areas of Changsha and Fudan) [5,7,8,9,10]. The reason for distinct epidemics of RT017 is not clear, high-level antimicrobial resistance may be one of the key contributing factors
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