Abstract
Clostridium difficile infection (CDI) has become a worldwide public health problem causing high mortality and a large disease burden. Molecular typing and analysis is important for surveillance and infection control of CDI. However, molecular characterization of C. difficile across China is extremely rare. Here, we report on the toxin profiles, molecular subtyping with multilocus sequence typing (MLST) and PCR ribotyping, and epidemiological characteristics of 199 C. difficile isolates collected between 2010 through 2015 from 13 participating centers across China. We identified 35 STs and 27 ribotypes (RTs) among the 199 C. difficile isolates: ST35 (15.58%), ST3 (15.08%), ST37 (12.06%), and RT017 (14.07%), RT001 (12.06%), RT012 (11.56%) are the most prevalent. One isolate with ST1 and 8 isolates with ST 11 were identified. We identified a new ST in this study, denoted ST332. The toxin profile tcdA+tcdB+tcdC+tcdR+tcdE+CDT- (65.83%) was the predominant profile. Furthermore, 11 isolates with positive binary toxin genes were discovered. According to the PCR ribotyping, one isolate with RT 027, and 6 isolates with RT 078 were confirmed. The epidemiological characteristics of C. difficile in China shows geographical differences, and both the toxin profile and molecular types exhibit great diversity across the different areas.
Highlights
Clostridium difficile is considered to be the leading cause of antimicrobial-associated diarrhea and has been observed in older inpatients (Rupnik et al, 2009)
In addition to toxins A and B, some C. difficile isolates can produce binary toxin, encoded by cdtA and cdtB genes, and it’s exact role in the pathogenesis of C. difficile infection (CDI) is unknown (Voth and Ballard, 2005). Molecular methods such as PCR ribotyping, pulsed field gel electrophoresis (PFGE), multilocus variable number tandem repeat analysis (MLVA), Molecular Typing of Clostridium difficile in China multilocus sequence typing (MLST), restriction endonuclease analysis (REA), and amplified fragment length polymorphism (AFLP) have been applied to C. difficile isolates responsible for clinical infections (Knetsch et al, 2013)
Multilocus sequence typing results showed that the 199 C. difficile isolates formed 35 ST types, with a high degree of discrete characteristics (Figure 1B), within which 30 ST types were obtained from 100 C. difficile strains (S1)
Summary
Clostridium difficile is considered to be the leading cause of antimicrobial-associated diarrhea and has been observed in older inpatients (Rupnik et al, 2009). In addition to toxins A and B, some C. difficile isolates can produce binary toxin, encoded by cdtA and cdtB genes, and it’s exact role in the pathogenesis of CDI is unknown (Voth and Ballard, 2005). Molecular methods such as PCR ribotyping, pulsed field gel electrophoresis (PFGE), multilocus variable number tandem repeat analysis (MLVA), Molecular Typing of Clostridium difficile in China multilocus sequence typing (MLST), restriction endonuclease analysis (REA), and amplified fragment length polymorphism (AFLP) have been applied to C. difficile isolates responsible for clinical infections (Knetsch et al, 2013).
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