Clostridium difficile ribotypes 001, 017, and 027 are associated with lethal C. difficile infection in Hesse, Germany

Hesse State Health Office, Centre for Health Protection, Dillenburg, Germany.
Eurosurveillance: bulletin europeen sur les maladies transmissibles = European communicable disease bulletin (Impact Factor: 5.72). 09/2009; 14(45).
Source: PubMed


From January 2008 to April 2009, 72 cases of severe Clostridium difficile infection were reported from 18 different districts in the state of Hesse, Germany. A total of 41 C. difficile isolates from 41 patients were subjected to PCR ribotyping. PCR ribotype (RT) 027 was the most prevalent strain accounting for 24 of 41 (59%) of typed isolates, followed by RT 001 (eight isolates, 20%), RT 017 and 042 (two isolates each), and RT 003, 066, 078, 081, and RKI-034 (one isolate each). Eighteen patients had died within 30 days after admission. C. difficile was reported as underlying cause of or contributing to death in 14 patients, indicating a case fatality rate of 19%. The patients with lethal outcome attributable to C. difficile were 59-89 years-old (median 78 years). Ribotyping results were available for seven isolates associated with lethal outcome, which were identified as RT 027 in three and as RT 001 and 017 in two cases each. Our data suggest that C. difficile RT 027 is prevalent in some hospitals in Hesse and that, in addition to the possibly more virulent RT 027, other toxigenic C. difficile strains like RT 001 and 017 are associated with lethal C. difficile infections in this region.

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Available from: Mardjan Arvand, Oct 29, 2014
    • "The data from all these studies show that PCR-ribotype 001 is a long-term problematic epidemic strain in some European countries. The association of the PCR-ribotype 001, as well as PCRribotypes 017 and 027, with the lethal course of CDI in Hesse, Germany was reported by Arvand et al., where case fatality rate was 19 % of severe cases of CDI [23]. A European study revealed CDI contributed to death in 7 % [2] of cases. "
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    ABSTRACT: The purpose of this study was to determine the incidence of Clostridium difficile infections (CDI) and to characterise the isolates in 14 departments of ten academic hospitals in Slovakia. During a one-month study (September 2012) all unformed stool samples were investigated using a rapid test to detect the presence of GDH and toxins A/B. Positive samples were cultured anaerobically and C. difficile isolates were characterised by ribotyping, multiple-locus variable-number tandem repeats analysis, and gyrA, rpoB and ermB investigation. A total of 194 unformed stool samples were investigated and 38 (19.6 %) had a positive rapid test. Of 38 samples, 27 revealed a positive result for GDH and free toxins A/B in the stool, and 11 samples only for the presence of GDH. The mean CDI incidence in 2012 was 5.2 cases per 10,000 patient bed-days. Twenty C. difficile isolates were available for molecular analysis; seventeen belonged to PCR-ribotype 001 (85 %) whereas the remaining three isolates were identified as PCR-ribotypes 017, 078 and 449. MLVA of the PCR-ribotype 001 isolates identified two clonal complexes and a close genetic relatedness between isolates from six different hospitals. Molecular analysis of antibiotic-resistance determinants revealed the presence of ermB gene encoding resistance to the MLSB group of antibiotics in 90 % of isolates, and Thr82Ile amino acid substitution in the gyrA gene associated with resistance to fluoroquinolones in 85 % of isolates. We conclude that C. difficile PCR-ribotype 001 is the predominant PCR-ribotype in Slovakia with a strong potential for clonal spread and development of multidrug resistance.
    No preview · Article · May 2015 · European Journal of Clinical Microbiology
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    • "In 2008 the proportion of A−B+ isolates recovered from Korean CDI cases was 25.7% compared to 4.2% of isolates recovered in 1995 [10], [11]. After initially being thought as non-pathogenic it is now known that A−B+ toxinotypes can cause a wide spectrum of disease including pseudomembranous colitis and mortality [12], [13]. Toxin A−B+ isolates have typically been typed as Ribotype 017, however, in recent years some A−B+ strains isolated in China & Australia appear as distinctly separate ribotypes [14], [6]. "
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    ABSTRACT: Clostridium difficile is the most commonly associated cause of antibiotic associated disease (AAD), which caused ∼21,000 cases of AAD in 2011 in the U.K. alone. The golden Syrian hamster model of CDI is an acute model displaying many of the clinical features of C. difficile disease. Using this model we characterised three clinical strains of C. difficile, all differing in toxinotype; CD1342 (PaLoc negative), M68 (toxinotype VIII) & BI-7 (toxinotype III). The naturally occurring non-toxic strain colonised all hamsters within 1-day post challenge (d.p.c.) with high-levels of spores being shed in the faeces of animals that appeared well throughout the entire experiment. However, some changes including increased neutrophil influx and unclotted red blood cells were observed at early time points despite the fact that the known C. difficile toxins (TcdA, TcdB and CDT) are absent from the genome. In contrast, hamsters challenged with strain M68 resulted in a 45% mortality rate, with those that survived challenge remaining highly colonised. It is currently unclear why some hamsters survive infection, as bacterial & toxin levels and histology scores were similar to those culled at a similar time-point. Hamsters challenged with strain BI-7 resulted in a rapid fatal infection in 100% of the hamsters approximately 26 hr post challenge. Severe caecal pathology, including transmural neutrophil infiltrates and extensive submucosal damage correlated with high levels of toxin measured in gut filtrates ex vivo. These data describes the infection kinetics and disease outcomes of 3 clinical C. difficile isolates differing in toxin carriage and provides additional insights to the role of each toxin in disease progression.
    Full-text · Article · May 2013 · PLoS ONE
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    • "Acknowledging the limitations of different study designs, and excluding the study undertaken by Sundram et al. [24], 2,041 of 7,774 persons (26.3%) died within 30 days of CDI diagnosis. These figures include people identified with CDI in these studies who died within 30 days (all-cause mortality) [14,15,17-20,22,25-34]. "
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    ABSTRACT: Background Clostridium difficile infection (CDI) is a common cause of diarrhoea in hospitalised patients. Around the world, the incidence and severity of CDI appears to be increasing, particularly in the northern hemisphere. The purpose of this integrative review was to investigate and describe mortality in hospitalised patients with CDI. Methods A search of the literature between 1 January 2005 and 30 April 2011 focusing on mortality and CDI in hospitalised patients was conducted using electronic databases. Papers were reviewed and analysed individually and themes were combined using integrative methods. Results All cause mortality at 30 days varied from 9% to 38%. Three studies report attributable mortality at 30 days, varying from 5.7% to 6.9%. In hospital mortality ranged from 8% to 37.2% Conclusion All cause 30 day mortality appeared to be high, with 15 studies indicating a mortality of 15% or greater. Findings support the notion that CDI is a serious infection and measures to prevent and control CDI are needed. Future studies investigating the mortality of CDI in settings outside of Europe and North America are needed. Similarly, future studies should include data on patient co-morbidities.
    Full-text · Article · May 2012
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