Abstract
Clostridium difficile hyper-virulent ribotype 027 strain has become a significant concern globally, but has rarely been reported in Asian countries including China. Recently, a retrospective single-center study in Beijing, China, detected two ribotype 027 C. difficile isolates from two patients coming for outpatient visits in 2012 and 2013. We performed a systematic investigation of the two isolates (and patients). Both C. difficile isolates had the typical PCR ribotype 027 profile; were positive for tcdA, tcdB and binary toxin genes; belonged to multilocus sequence type 1 (ST1); had typical ribotype 027 deletions in the tcdC gene; and were highly-resistant to fluoroquinolones; but had a different MLVA profile and were not genetically related to any previously reported international ribotype 027 clones. A review of the patients’ medical records showed that neither received appropriate antimicrobial treatment and were lost to follow-up after outpatient visits. We propose that C. difficile infections caused by ribotype 027 are probably a neglected problem in China, and the subsequent impact of unawareness of this problem is worrying. Appropriate testing assays and multi-center or national level surveillance for C. difficile infections and specifically for ribotype 027 should be introduced to provide essential data and guide future clinical practice.
Highlights
Background for local laboratory diagnosis ofC. difficile infections.Stool specimens from suspected CDI cases are routinely sent to the PUMCH laboratory in Beijing for C. difficile detection
19 full text articles reporting on the detection of C. difficile ribotype 027 isolates were found, with 142 cases identified in eight regions (Fig. 2)[17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35]
The majority of CDI cases reported recently are largely associated with the emergence of epidemic ribotype 027 strain, with most of it reported from North America and Europe[36,37,38]
Summary
Background for local laboratory diagnosis ofC. difficile infections.Stool specimens from suspected CDI cases are routinely sent to the PUMCH laboratory in Beijing for C. difficile detection. Two C. difficile ribotype 027 isolates were detected, which are the first reported cases in Beijing, China. By capillary sequencer-based PCR ribotyping and querying against WEBRIBO database, two of the four above-mentioned binary toxin gene positive C. difficile isolates, namely PUCD235 and PUCD301, were confirmed as ribotype 027.
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