Predominance of Clostridium difficile Ribotypes 017 and 078 among Toxigenic Clinical Isolates in Southern Taiwan.

Yuan-Pin Hung,Pei-Jane Tsai,Jen-Chieh Lee,Yi-Hui Wu,Hsiao-Ju Lin,I-Hsiu Huang,Hsiao-Chieh Liu,Hsiu-Chuan Liu,Wen-Chien Ko,Bo-Yang Tsai,Abhishek Deshpande

doi:10.1371/journal.pone.0166159

Abstract

Ribotypes and toxin genotypes of clinical C. difficile isolates in Taiwan are rarely reported. A prospective surveillance study from January 2011 to January 2013 was conducted at the medical wards of a district hospital in southern Taiwan. Of the first toxigenic isolates from 120 patients, 68 (56.7%) of 120 isolates possessed both tcdA and tcdB. Of 52 (43.3%) with tcdB and truncated tcdA (tcdA-/tcdB+), all were ribotype 017 and none had binary toxin or tcdC deletion. Eighteen (15%) toxigenic isolates harbored binary toxins (cdtA and cdtB) and all had tcdC deletion, including Δ39 (C184T) deletion (14 isolates), Δ18 in-frame deletion (3 isolates), and Δ18 (Δ117A) deletion (1 isolate). Eleven of 14 isolates with Δ39 (C184T) deletion belonged to the ribotype 078 family, including ribotype 127 (6 isolates), ribotype 126 (4 isolates), and ribotype 078 (1 isolate). Among 8 patients with consecutive C. difficile isolates, these isolates from 6 (75%) patients were identical, irrespective of the presence or absence of diarrhea, suggestive of persistent fecal carriage or colonization. In conclusion in southern Taiwan, ribotype 017 isolates with a tcdA-/tcdB+ genotype were not uncommon and of C. difficile isolates with binary toxin, the ribotype 078 family was predominant.

Highlights

Clostridium difficile is the leading cause of nosocomial diarrhea with an increase in the incidence of sporadic outbreaks causing severe and fatal infections since the beginning of the century [1]
Most alarming is the outbreak of C. difficile infections (CDIs) in Quebec, Canada in 2003
In this study we aimed to investigate the toxin gene content and ribotype distribution of C. difficile isolates with tcdC deletion collected from previous studies [13,14,15]

Summary

Introduction

Clostridium difficile is the leading cause of nosocomial diarrhea with an increase in the incidence of sporadic outbreaks causing severe and fatal infections since the beginning of the century [1]. Most alarming is the outbreak of C. difficile infections (CDIs) in Quebec, Canada in 2003. During the outbreak involving 1,703 patients, CDI was the attributable cause of death in PLOS ONE | DOI:10.1371/journal.pone.0166159. Ribotype Distribution of Toxigenic Clostridium difficile Isolates During the outbreak involving 1,703 patients, CDI was the attributable cause of death in PLOS ONE | DOI:10.1371/journal.pone.0166159 November 18, 2016

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