High frequency of toxigenic Clostridium difficile and Clostridium perfringens coinfection among diarrheic patients at health care facility-onset (HCFO) and community-onset (CO) centers in Bogot\xe1, Colombia

Alex J Forero,Claudia Birchenall,Marina Muñoz,Dora I Ríos-Chaparro,Milena Camargo,Diego F Josa,Sara C Soto-De León,Juan D Ramírez,Darío Pinilla,Juan M Pardo,Manuel A Patarroyo

doi:10.1186/s13099-019-0308-7

Abstract

BackgroundThe aim of this study was to evaluate the frequency of toxigenic C. difficile and C. perfringens infections at health care facility-onset (HCFO) and community-onset (CO), in two health care centers (HCC) in Bogotá, Colombia. A total of 220 stool samples from patients presenting diarrhea acquired at HCFO or CO were analyzed by several PCR tests.ResultsWe found that 65.5% (n = 144) of the population had C. difficile infection, followed by toxigenic C. difficile with 57.3% (n = 126), and finally toxigenic C. perfringens with a frequency of 32.7% (n = 72).ConclusionsThis study is the first molecular detection and characterization of C. difficile and C. perfringens in HCFO and CO in Latin America and demonstrates a relevant frequency of these two species, including coinfection and strikingly diverse toxigenic profiles, especially in the CO.

Highlights

Clostridium difficile is one of the most studied clostridial species, as it leads to developing diarrhea associated with the use of antibiotics at the hospital level [1]
Frequency of C. difficile/C. perfringens infection and/ or coinfection A total of 85.0% (n = 187) of stool samples from patients with diarrhea collected for this study came from health care centers (HCC)-1, and the remaining 15.0% (n = 33) were from HCC-2
Of the total samples collected in HCC-1, the majority were obtained from CO patients (70.0%, n = 131), while in the case of HCC-2, the majority came from health care facility-onset (HCFO) patients (78.8%, n = 26)

Summary

Introduction

Clostridium difficile is one of the most studied clostridial species, as it leads to developing diarrhea associated with the use of antibiotics at the hospital level [1]. The main virulence factors of C. difficile are Toxin A (TcdA) and Toxin B (TcdB), belonging to the large family of Clostridial toxins with glucosyltransferase activity [2]. These toxins are encoded by genes located in a region of the chromosome of approximately 20 Kb, which constitutes the pathogenicity locus (PaLoc). Diarrhea can be caused by C. perfringens, a species that is widely distributed in various hosts and environments, and that has been related to histotoxic and intestinal infections in animals and humans. A total of 220 stool samples from patients presenting diarrhea acquired at HCFO or CO were analyzed by several PCR tests

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