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Characterisation and Carriage Ratio of Clostridium difficile Strains Isolated from a Community-Dwelling Elderly Population in the United Kingdom

BACKGROUND: Community-associated Clostridium difficile infection (CDI) appears to be an increasing problem. Reported carriage rates by C.difficile are debatable with suggestions that primary asymptomatic carriage is associated with decreased risk of subsequent diarrhoea. However, knowledge of potent...

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Autores principales: Miyajima, Fabio, Roberts, Paul, Swale, Andrew, Price, Valerie, Jones, Maureen, Horan, Michael, Beeching, Nicholas, Brazier, Jonathan, Parry, Christopher, Pendleton, Neil, Pirmohamed, Munir
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3160286/
https://www.ncbi.nlm.nih.gov/pubmed/21886769
http://dx.doi.org/10.1371/journal.pone.0022804
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author Miyajima, Fabio
Roberts, Paul
Swale, Andrew
Price, Valerie
Jones, Maureen
Horan, Michael
Beeching, Nicholas
Brazier, Jonathan
Parry, Christopher
Pendleton, Neil
Pirmohamed, Munir
author_facet Miyajima, Fabio
Roberts, Paul
Swale, Andrew
Price, Valerie
Jones, Maureen
Horan, Michael
Beeching, Nicholas
Brazier, Jonathan
Parry, Christopher
Pendleton, Neil
Pirmohamed, Munir
author_sort Miyajima, Fabio
collection PubMed
description BACKGROUND: Community-associated Clostridium difficile infection (CDI) appears to be an increasing problem. Reported carriage rates by C.difficile are debatable with suggestions that primary asymptomatic carriage is associated with decreased risk of subsequent diarrhoea. However, knowledge of potential reservoirs and intestinal carriage rates in the community, particularly in the elderly, the most susceptible group, is limited. We have determined the presence of C.difficile in the faeces of a healthy elderly cohort living outside of long-term care facilities (LCFs) in the United Kingdom. METHODS: Faecal samples from 149 community-based healthy elderly volunteers (median age 81 years) were screened for C.difficile using direct (Brazier's CCEY) and enrichment (Cooked Meat broth) culture methods and a glutamate dehydrogenase (GDH) immunoassay. Isolates were PCR-ribotyped and analysed for toxin production and the presence of toxin genes. RESULTS: Of 149 faecal samples submitted, six (4%) were found to contain C.difficile. One particular sample was positive by both the GDH immunoassay and direct culture, and concurrently produced two distinct strain types: one toxigenic and the other non-toxigenic. The other five samples were only positive by enrichment culture method. Overall, four C.difficile isolates were non-toxigenic (PCR-ribotypes 009, 026 (n = 2) and 039), while three were toxigenic (PCR-ribotypes 003, 005 and 106). All individuals who had a positive culture were symptom-free and none of them had a history of CDI and/or antibiotics use in the 3 month period preceding recruitment. CONCLUSIONS: To our knowledge, this is the first study of the presence of C.difficile in healthy elderly community-dwelling individuals residing outside of LCFs. The observed carriage rate is lower than that reported for individuals in LCFs and interestingly no individual carried the common epidemic strain PCR-ribotype 027 (NAP1/BI). Further follow-up of asymptomatic carriers in the community, is required to evaluate host susceptibility to CDI and identify dynamic changes in the host and microbial environment that are associated with pathogenicity.
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spelling pubmed-31602862011-08-30 Characterisation and Carriage Ratio of Clostridium difficile Strains Isolated from a Community-Dwelling Elderly Population in the United Kingdom Miyajima, Fabio Roberts, Paul Swale, Andrew Price, Valerie Jones, Maureen Horan, Michael Beeching, Nicholas Brazier, Jonathan Parry, Christopher Pendleton, Neil Pirmohamed, Munir PLoS One Research Article BACKGROUND: Community-associated Clostridium difficile infection (CDI) appears to be an increasing problem. Reported carriage rates by C.difficile are debatable with suggestions that primary asymptomatic carriage is associated with decreased risk of subsequent diarrhoea. However, knowledge of potential reservoirs and intestinal carriage rates in the community, particularly in the elderly, the most susceptible group, is limited. We have determined the presence of C.difficile in the faeces of a healthy elderly cohort living outside of long-term care facilities (LCFs) in the United Kingdom. METHODS: Faecal samples from 149 community-based healthy elderly volunteers (median age 81 years) were screened for C.difficile using direct (Brazier's CCEY) and enrichment (Cooked Meat broth) culture methods and a glutamate dehydrogenase (GDH) immunoassay. Isolates were PCR-ribotyped and analysed for toxin production and the presence of toxin genes. RESULTS: Of 149 faecal samples submitted, six (4%) were found to contain C.difficile. One particular sample was positive by both the GDH immunoassay and direct culture, and concurrently produced two distinct strain types: one toxigenic and the other non-toxigenic. The other five samples were only positive by enrichment culture method. Overall, four C.difficile isolates were non-toxigenic (PCR-ribotypes 009, 026 (n = 2) and 039), while three were toxigenic (PCR-ribotypes 003, 005 and 106). All individuals who had a positive culture were symptom-free and none of them had a history of CDI and/or antibiotics use in the 3 month period preceding recruitment. CONCLUSIONS: To our knowledge, this is the first study of the presence of C.difficile in healthy elderly community-dwelling individuals residing outside of LCFs. The observed carriage rate is lower than that reported for individuals in LCFs and interestingly no individual carried the common epidemic strain PCR-ribotype 027 (NAP1/BI). Further follow-up of asymptomatic carriers in the community, is required to evaluate host susceptibility to CDI and identify dynamic changes in the host and microbial environment that are associated with pathogenicity. Public Library of Science 2011-08-23 /pmc/articles/PMC3160286/ /pubmed/21886769 http://dx.doi.org/10.1371/journal.pone.0022804 Text en Miyajima et al. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Miyajima, Fabio
Roberts, Paul
Swale, Andrew
Price, Valerie
Jones, Maureen
Horan, Michael
Beeching, Nicholas
Brazier, Jonathan
Parry, Christopher
Pendleton, Neil
Pirmohamed, Munir
Characterisation and Carriage Ratio of Clostridium difficile Strains Isolated from a Community-Dwelling Elderly Population in the United Kingdom
title Characterisation and Carriage Ratio of Clostridium difficile Strains Isolated from a Community-Dwelling Elderly Population in the United Kingdom
title_full Characterisation and Carriage Ratio of Clostridium difficile Strains Isolated from a Community-Dwelling Elderly Population in the United Kingdom
title_fullStr Characterisation and Carriage Ratio of Clostridium difficile Strains Isolated from a Community-Dwelling Elderly Population in the United Kingdom
title_full_unstemmed Characterisation and Carriage Ratio of Clostridium difficile Strains Isolated from a Community-Dwelling Elderly Population in the United Kingdom
title_short Characterisation and Carriage Ratio of Clostridium difficile Strains Isolated from a Community-Dwelling Elderly Population in the United Kingdom
title_sort characterisation and carriage ratio of clostridium difficile strains isolated from a community-dwelling elderly population in the united kingdom
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3160286/
https://www.ncbi.nlm.nih.gov/pubmed/21886769
http://dx.doi.org/10.1371/journal.pone.0022804
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