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Colonization of toxigenic Clostridium difficile among ICU patients: a prospective study

BACKGROUND: A prospective study was performed to investigate the prevalence of colonization among ICU patients and to examine whether asymptomatic carriers were the source of subsequent C. difficile infection (CDI) and acquisition of toxigenic C. difficile. METHODS: Rectal swabs were collected from...

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Autores principales: Zhang, Xiaoxia, Wang, Xiaohui, Yang, Jingyu, Liu, Xiaohua, Cai, Lin, Zong, Zhiyong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4977703/
https://www.ncbi.nlm.nih.gov/pubmed/27506470
http://dx.doi.org/10.1186/s12879-016-1729-2
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author Zhang, Xiaoxia
Wang, Xiaohui
Yang, Jingyu
Liu, Xiaohua
Cai, Lin
Zong, Zhiyong
author_facet Zhang, Xiaoxia
Wang, Xiaohui
Yang, Jingyu
Liu, Xiaohua
Cai, Lin
Zong, Zhiyong
author_sort Zhang, Xiaoxia
collection PubMed
description BACKGROUND: A prospective study was performed to investigate the prevalence of colonization among ICU patients and to examine whether asymptomatic carriers were the source of subsequent C. difficile infection (CDI) and acquisition of toxigenic C. difficile. METHODS: Rectal swabs were collected from adult patients on admission to and at discharge from a 50-bed medical ICU of a major referral hospital in western China, from August to November 2014. Stools were collected from patients who developed ICU-onset diarrhea. Both swabs and stools were screened for tcdB (toxin B gene) by PCR. Samples positive to tcdB were cultured for C. difficile and isolates recovered were screened for tcdB and the binary toxin genes by PCR. Strain typing was performed using multilocus sequence typing and isolates belonging to the same sequence type (ST) were further typed using multiple-locus variable number tandem repeat analysis (MLVA). RESULTS: During the 4-month period, rectal swabs were collected from 360 (90.9 %) out of 396 patients who were admitted to the ICU. Among the 360 patients, 314 had stayed in the ICU more than 3 days, of which 213 (73.6 %) had a rectal swab collected within the 3 days prior to discharge from ICU. The prevalence of toxigenic C. difficile colonization was 1.7 % (6 cases) and 4.3 % (10 cases) on admission and discharge, respectively. Only four (1.1 %) out of 360 patients had CDI, corresponding to 10.7 cases per 10,000 ICU days. None of the four cases had toxigenic C. difficile either on admission or at discharge. Toxigenic C. difficile isolates were recovered from all swabs and stool samples positive for tcdB by PCR and belonged to 7 STs (ST2, 3, 6, 37, 54, 103 and 129). None of the isolates belonging to the same ST had identical MLVA patterns. Binary toxin genes were detected in one ST103 isolate that caused colonization. CONCLUSION: The prevalence of colonization with toxigenic C. difficile among patients on admission to ICU was low in our setting. ICU-acquired toxigenic C. difficile were not linked to those detected on admission. Active screening for toxigenic C. difficile may not be a resource-efficient measure in settings with a low prevalence of colonization.
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spelling pubmed-49777032016-08-17 Colonization of toxigenic Clostridium difficile among ICU patients: a prospective study Zhang, Xiaoxia Wang, Xiaohui Yang, Jingyu Liu, Xiaohua Cai, Lin Zong, Zhiyong BMC Infect Dis Research Article BACKGROUND: A prospective study was performed to investigate the prevalence of colonization among ICU patients and to examine whether asymptomatic carriers were the source of subsequent C. difficile infection (CDI) and acquisition of toxigenic C. difficile. METHODS: Rectal swabs were collected from adult patients on admission to and at discharge from a 50-bed medical ICU of a major referral hospital in western China, from August to November 2014. Stools were collected from patients who developed ICU-onset diarrhea. Both swabs and stools were screened for tcdB (toxin B gene) by PCR. Samples positive to tcdB were cultured for C. difficile and isolates recovered were screened for tcdB and the binary toxin genes by PCR. Strain typing was performed using multilocus sequence typing and isolates belonging to the same sequence type (ST) were further typed using multiple-locus variable number tandem repeat analysis (MLVA). RESULTS: During the 4-month period, rectal swabs were collected from 360 (90.9 %) out of 396 patients who were admitted to the ICU. Among the 360 patients, 314 had stayed in the ICU more than 3 days, of which 213 (73.6 %) had a rectal swab collected within the 3 days prior to discharge from ICU. The prevalence of toxigenic C. difficile colonization was 1.7 % (6 cases) and 4.3 % (10 cases) on admission and discharge, respectively. Only four (1.1 %) out of 360 patients had CDI, corresponding to 10.7 cases per 10,000 ICU days. None of the four cases had toxigenic C. difficile either on admission or at discharge. Toxigenic C. difficile isolates were recovered from all swabs and stool samples positive for tcdB by PCR and belonged to 7 STs (ST2, 3, 6, 37, 54, 103 and 129). None of the isolates belonging to the same ST had identical MLVA patterns. Binary toxin genes were detected in one ST103 isolate that caused colonization. CONCLUSION: The prevalence of colonization with toxigenic C. difficile among patients on admission to ICU was low in our setting. ICU-acquired toxigenic C. difficile were not linked to those detected on admission. Active screening for toxigenic C. difficile may not be a resource-efficient measure in settings with a low prevalence of colonization. BioMed Central 2016-08-09 /pmc/articles/PMC4977703/ /pubmed/27506470 http://dx.doi.org/10.1186/s12879-016-1729-2 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Zhang, Xiaoxia
Wang, Xiaohui
Yang, Jingyu
Liu, Xiaohua
Cai, Lin
Zong, Zhiyong
Colonization of toxigenic Clostridium difficile among ICU patients: a prospective study
title Colonization of toxigenic Clostridium difficile among ICU patients: a prospective study
title_full Colonization of toxigenic Clostridium difficile among ICU patients: a prospective study
title_fullStr Colonization of toxigenic Clostridium difficile among ICU patients: a prospective study
title_full_unstemmed Colonization of toxigenic Clostridium difficile among ICU patients: a prospective study
title_short Colonization of toxigenic Clostridium difficile among ICU patients: a prospective study
title_sort colonization of toxigenic clostridium difficile among icu patients: a prospective study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4977703/
https://www.ncbi.nlm.nih.gov/pubmed/27506470
http://dx.doi.org/10.1186/s12879-016-1729-2
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