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ICU-Onset Clostridium difficile infection in a university hospital in China: a prospective cohort study.

Wang X, Cai L, Yu R, Huang W, Zong Z - PLoS ONE (2014)

Bottom Line: Toxigenic C. difficile isolates were recovered from 28 out of the 31 patients with CDI. cdtA and cdtB were found in two strains.The incidence of ICU-onset CDI here is similar to those in Europe and North America, suggesting that CDI is likely to be a common problem in China.Toxigenic C. difficile here belonged to a variety of STs, which may represent a significant clonal expansion rather than the true clonal diversity.

View Article: PubMed Central - PubMed

Affiliation: Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China; Division of Infectious Diseases, State Key Laboratory of Biotherapy, Chengdu, China.

ABSTRACT
A prospective study was conducted to investigate the incidence, clinical profiles and outcome of ICU-onset CDI in a 50-bed medical ICU at a university hospital in China. Stools were collected from patients who developed ICU-onset diarrhea and was screened for tcdA (toxin A gene) and tcdB (toxin B gene) by PCR. CDI cases were compared with the ICU-onset non-CDI diarrhea cases for demographics, comorbidities, potential risk factors, major laboratory findings and outcomes. Stool samples from CDI cases were subjected to C. difficile culture and C. difficile isolates were screened for tcdA, tcdB and the binary toxin genes (cdtA and cdtB) using multiplex PCR. Strain typing of toxigenic C. difficile isolates was performed using multilocus sequence typing. There were 1,277 patients in the ICU during the study period and 124 (9.7%) developed ICU-onset diarrhea, of which 31 patients had CDI. The incidence of ICU-onset CDI was 25.2 cases per 10,000 ICU days. ICU-onset CDI cases had similar features with ICU-onset non-CDI diarrhea cases including the use of proton pump inhibitors and antibacterial agents. The crude mortality rate of ICU-onset CDI was 22.6%, but the attributable mortality rate of ICU-onset CDI was only 3.2% here. Toxigenic C. difficile isolates were recovered from 28 out of the 31 patients with CDI. cdtA and cdtB were found in two strains. Seventeen STs including 11 new STs were identified. All of the 11 new STs were single-locus variants of known STs and the 17 STs identified here could be clustered into 3 clades. The incidence of ICU-onset CDI here is similar to those in Europe and North America, suggesting that CDI is likely to be a common problem in China. Toxigenic C. difficile here belonged to a variety of STs, which may represent a significant clonal expansion rather than the true clonal diversity.

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The relatedness of the STs seen in this study.The relatedness of STs were established using eBURST. ST209 and ST213 are a single-locus variant of ST5 and ST99, respectively.
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pone-0111735-g001: The relatedness of the STs seen in this study.The relatedness of STs were established using eBURST. ST209 and ST213 are a single-locus variant of ST5 and ST99, respectively.

Mentions: A total of 17 STs, including 11 new STs, were assigned for the 28 isolates (16 STs) and the three stool DNA samples (three STs; Table 2). This appears to suggest a remarkable clonal diversity in a single unit during a relative short period. However, all of the 11 new STs were single-locus variants of known STs. most of which were also found here (Figure 1). In addition, the 17 STs identified here belonged to 4 CCs and could be clustered into 3 clades (Table 2). The diversity of toxigenic C. difficile in this 50-bed unit is therefore largely a reflection of a significant clonal expansion. ST3 (n = 5), ST35 (n = 4) and ST54 (n = 3) were the most common types among A+B+ strains, while A−B+ strains belonged to ST37 or its single-locus variants. This is consistent with the findings in a university hospital in Zhejiang province, China [18]. In contrast, ST35, ST37 and ST54 were rarely identified in a large European survey [4], though ST2 (ribotype 014/020) and ST3 (ribotype 001) have also been found to be prevalent. Of note, ST1 (PCR ribotype 027), a hypervirulent type widely distributed in Europe and North America, and ST11 (ribotype 078), a type associated with community-acquired CDI commonly found in Europe, were not detected in this study. In China, only one strain of ribotype 027 and one strain of ribotype of 078 have been reported up to now [20], [21].


ICU-Onset Clostridium difficile infection in a university hospital in China: a prospective cohort study.

Wang X, Cai L, Yu R, Huang W, Zong Z - PLoS ONE (2014)

The relatedness of the STs seen in this study.The relatedness of STs were established using eBURST. ST209 and ST213 are a single-locus variant of ST5 and ST99, respectively.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4221109&req=5

pone-0111735-g001: The relatedness of the STs seen in this study.The relatedness of STs were established using eBURST. ST209 and ST213 are a single-locus variant of ST5 and ST99, respectively.
Mentions: A total of 17 STs, including 11 new STs, were assigned for the 28 isolates (16 STs) and the three stool DNA samples (three STs; Table 2). This appears to suggest a remarkable clonal diversity in a single unit during a relative short period. However, all of the 11 new STs were single-locus variants of known STs. most of which were also found here (Figure 1). In addition, the 17 STs identified here belonged to 4 CCs and could be clustered into 3 clades (Table 2). The diversity of toxigenic C. difficile in this 50-bed unit is therefore largely a reflection of a significant clonal expansion. ST3 (n = 5), ST35 (n = 4) and ST54 (n = 3) were the most common types among A+B+ strains, while A−B+ strains belonged to ST37 or its single-locus variants. This is consistent with the findings in a university hospital in Zhejiang province, China [18]. In contrast, ST35, ST37 and ST54 were rarely identified in a large European survey [4], though ST2 (ribotype 014/020) and ST3 (ribotype 001) have also been found to be prevalent. Of note, ST1 (PCR ribotype 027), a hypervirulent type widely distributed in Europe and North America, and ST11 (ribotype 078), a type associated with community-acquired CDI commonly found in Europe, were not detected in this study. In China, only one strain of ribotype 027 and one strain of ribotype of 078 have been reported up to now [20], [21].

Bottom Line: Toxigenic C. difficile isolates were recovered from 28 out of the 31 patients with CDI. cdtA and cdtB were found in two strains.The incidence of ICU-onset CDI here is similar to those in Europe and North America, suggesting that CDI is likely to be a common problem in China.Toxigenic C. difficile here belonged to a variety of STs, which may represent a significant clonal expansion rather than the true clonal diversity.

View Article: PubMed Central - PubMed

Affiliation: Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China; Division of Infectious Diseases, State Key Laboratory of Biotherapy, Chengdu, China.

ABSTRACT
A prospective study was conducted to investigate the incidence, clinical profiles and outcome of ICU-onset CDI in a 50-bed medical ICU at a university hospital in China. Stools were collected from patients who developed ICU-onset diarrhea and was screened for tcdA (toxin A gene) and tcdB (toxin B gene) by PCR. CDI cases were compared with the ICU-onset non-CDI diarrhea cases for demographics, comorbidities, potential risk factors, major laboratory findings and outcomes. Stool samples from CDI cases were subjected to C. difficile culture and C. difficile isolates were screened for tcdA, tcdB and the binary toxin genes (cdtA and cdtB) using multiplex PCR. Strain typing of toxigenic C. difficile isolates was performed using multilocus sequence typing. There were 1,277 patients in the ICU during the study period and 124 (9.7%) developed ICU-onset diarrhea, of which 31 patients had CDI. The incidence of ICU-onset CDI was 25.2 cases per 10,000 ICU days. ICU-onset CDI cases had similar features with ICU-onset non-CDI diarrhea cases including the use of proton pump inhibitors and antibacterial agents. The crude mortality rate of ICU-onset CDI was 22.6%, but the attributable mortality rate of ICU-onset CDI was only 3.2% here. Toxigenic C. difficile isolates were recovered from 28 out of the 31 patients with CDI. cdtA and cdtB were found in two strains. Seventeen STs including 11 new STs were identified. All of the 11 new STs were single-locus variants of known STs and the 17 STs identified here could be clustered into 3 clades. The incidence of ICU-onset CDI here is similar to those in Europe and North America, suggesting that CDI is likely to be a common problem in China. Toxigenic C. difficile here belonged to a variety of STs, which may represent a significant clonal expansion rather than the true clonal diversity.

Show MeSH
Related in: MedlinePlus