Cargando…
Molecular Epidemiology of Clostridium difficile Infection in a Large Teaching Hospital in Thailand
Clostridium difficile infection (CDI) is a leading cause of healthcare-associated morbidity and mortality worldwide. In Thailand, CDI exhibits low recurrence and mortality and its molecular epidemiology is unknown. CDI surveillance was conducted in a tertiary facility (Siriraj Hospital, Bangkok). A...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2015
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4441498/ https://www.ncbi.nlm.nih.gov/pubmed/26000789 http://dx.doi.org/10.1371/journal.pone.0127026 |
_version_ | 1782372804851662848 |
---|---|
author | Ngamskulrungroj, Popchai Sanmee, Sittinee Pusathit, Papanin Piewngam, Pipat Elliott, Briony Riley, Thomas V. Kiratisin, Pattarachai |
author_facet | Ngamskulrungroj, Popchai Sanmee, Sittinee Pusathit, Papanin Piewngam, Pipat Elliott, Briony Riley, Thomas V. Kiratisin, Pattarachai |
author_sort | Ngamskulrungroj, Popchai |
collection | PubMed |
description | Clostridium difficile infection (CDI) is a leading cause of healthcare-associated morbidity and mortality worldwide. In Thailand, CDI exhibits low recurrence and mortality and its molecular epidemiology is unknown. CDI surveillance was conducted in a tertiary facility (Siriraj Hospital, Bangkok). A total of 53 toxigenic C. difficile strains from Thai patients were analyzed by multi-locus sequence typing (MLST), PCR ribotyping, and pulse-field gel electrophoresis (PFGE). The mean age of the cohort was 64 years and 62.3% were female; 37.7% of patients were exposed to > two antibiotics prior to a diagnosis of CDI, with beta-lactams the most commonly used drug (56.3%). Metronidazole was used most commonly (77.5%; success rate 83.9%), and non-responders were treated with vancomycin (success rate 100%). None of the isolates carried binary toxin genes. Most isolates (98.2–100%) were susceptible to metronidazole, vancomycin, tigecycline and daptomycin. There were 11 sequence types (STs), 13 ribotypes (RTs) and four PFGE types. Six previously identified STs (ST12, ST13, ST14, ST33, ST41 and ST45) and five novel STs unique to Thailand (ST66, ST67, ST68, ST69 and ST70) were identified. PCR RTs UK 017 (ST45) (45.3%) and UK 014/020 (ST33) (24.5%) were the most common. High concordance was observed between the MLST and ribotyping results (p<0.001). C. difficile isolates from Thai patients were highly susceptible to standard antimicrobial agents. In conclusion, the five STs indicate the high genetic diversity and unique polymorphisms in Thailand. Moreover, the emergence of antimicrobial resistance to vancomycin warranted continuous surveillance to prevent further spread of the toxigenic C. difficile isolates. |
format | Online Article Text |
id | pubmed-4441498 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-44414982015-05-28 Molecular Epidemiology of Clostridium difficile Infection in a Large Teaching Hospital in Thailand Ngamskulrungroj, Popchai Sanmee, Sittinee Pusathit, Papanin Piewngam, Pipat Elliott, Briony Riley, Thomas V. Kiratisin, Pattarachai PLoS One Research Article Clostridium difficile infection (CDI) is a leading cause of healthcare-associated morbidity and mortality worldwide. In Thailand, CDI exhibits low recurrence and mortality and its molecular epidemiology is unknown. CDI surveillance was conducted in a tertiary facility (Siriraj Hospital, Bangkok). A total of 53 toxigenic C. difficile strains from Thai patients were analyzed by multi-locus sequence typing (MLST), PCR ribotyping, and pulse-field gel electrophoresis (PFGE). The mean age of the cohort was 64 years and 62.3% were female; 37.7% of patients were exposed to > two antibiotics prior to a diagnosis of CDI, with beta-lactams the most commonly used drug (56.3%). Metronidazole was used most commonly (77.5%; success rate 83.9%), and non-responders were treated with vancomycin (success rate 100%). None of the isolates carried binary toxin genes. Most isolates (98.2–100%) were susceptible to metronidazole, vancomycin, tigecycline and daptomycin. There were 11 sequence types (STs), 13 ribotypes (RTs) and four PFGE types. Six previously identified STs (ST12, ST13, ST14, ST33, ST41 and ST45) and five novel STs unique to Thailand (ST66, ST67, ST68, ST69 and ST70) were identified. PCR RTs UK 017 (ST45) (45.3%) and UK 014/020 (ST33) (24.5%) were the most common. High concordance was observed between the MLST and ribotyping results (p<0.001). C. difficile isolates from Thai patients were highly susceptible to standard antimicrobial agents. In conclusion, the five STs indicate the high genetic diversity and unique polymorphisms in Thailand. Moreover, the emergence of antimicrobial resistance to vancomycin warranted continuous surveillance to prevent further spread of the toxigenic C. difficile isolates. Public Library of Science 2015-05-22 /pmc/articles/PMC4441498/ /pubmed/26000789 http://dx.doi.org/10.1371/journal.pone.0127026 Text en © 2015 Ngamskulrungroj 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 Ngamskulrungroj, Popchai Sanmee, Sittinee Pusathit, Papanin Piewngam, Pipat Elliott, Briony Riley, Thomas V. Kiratisin, Pattarachai Molecular Epidemiology of Clostridium difficile Infection in a Large Teaching Hospital in Thailand |
title | Molecular Epidemiology of Clostridium difficile Infection in a Large Teaching Hospital in Thailand |
title_full | Molecular Epidemiology of Clostridium difficile Infection in a Large Teaching Hospital in Thailand |
title_fullStr | Molecular Epidemiology of Clostridium difficile Infection in a Large Teaching Hospital in Thailand |
title_full_unstemmed | Molecular Epidemiology of Clostridium difficile Infection in a Large Teaching Hospital in Thailand |
title_short | Molecular Epidemiology of Clostridium difficile Infection in a Large Teaching Hospital in Thailand |
title_sort | molecular epidemiology of clostridium difficile infection in a large teaching hospital in thailand |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4441498/ https://www.ncbi.nlm.nih.gov/pubmed/26000789 http://dx.doi.org/10.1371/journal.pone.0127026 |
work_keys_str_mv | AT ngamskulrungrojpopchai molecularepidemiologyofclostridiumdifficileinfectioninalargeteachinghospitalinthailand AT sanmeesittinee molecularepidemiologyofclostridiumdifficileinfectioninalargeteachinghospitalinthailand AT pusathitpapanin molecularepidemiologyofclostridiumdifficileinfectioninalargeteachinghospitalinthailand AT piewngampipat molecularepidemiologyofclostridiumdifficileinfectioninalargeteachinghospitalinthailand AT elliottbriony molecularepidemiologyofclostridiumdifficileinfectioninalargeteachinghospitalinthailand AT rileythomasv molecularepidemiologyofclostridiumdifficileinfectioninalargeteachinghospitalinthailand AT kiratisinpattarachai molecularepidemiologyofclostridiumdifficileinfectioninalargeteachinghospitalinthailand |