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Molecular Epidemiology of Clostridium difficile Infection in Hospitalized Patients in Eastern China.

Research paper by Dazhi D Jin, Yun Y Luo, Chen C Huang, Jian J Cai, Julian J Ye, Yi Y Zheng, Liqian L Wang, Peng P Zhao, Anbing A Liu, Weijia W Fang, Xianjun X Wang, Shichang S Xia, Jianmin J Jiang, Yi-Wei YW Tang

Indexed on: 16 Dec '16Published on: 16 Dec '16Published in: Journal of clinical microbiology



Abstract

Few studies on risk factors and transmission of Clostridium difficile infection (CDI) have been reported from China. A cross-sectional study was conducted for three years in Eastern China. Consecutive stool specimens from hospitalized patients with diarrhea were cultured for C. difficile C. difficle isolates from these patients then were analyzed for toxin genes, genotypes and antimicrobial resistance. Severity of CDI was determined in each patient by a blinded review of the medical record and ranged from 1 to 6. A total of 397 patients (10.0%) out of 3,953 patients with diarrhea were found to have CDI. Severity of CDI was mild to moderate with an average severity score of 2.61±1.01. C. difficile was isolated from stool specimens in 432 (10.9%) of all patients having diarrhea. C. difficile genotypes were determined by multilocus sequence analysis (ST) and PCR ribotyping (RT); ST37/RT017 (n=68, 16.5%) was the dominant genotype. Eleven patients (16.2%) with this genotype had a CDI severity score of 5. Overall, three RTs and four STs were predominant; these genotypes were associated with significantly different antimicrobial resistance patterns in comparison to all genotypes (χ(2)=79.56-97.76, p < 0.001). Independent risk factors associated with CDI included the following: age over 55-years [odds ratio (95% confidence intervals), 26.80 (18.76-38.29)], previous hospitalization [12.42 (8.85-17.43)], previous antimicrobial treatment within 8 weeks [150.56 (73.11-310.06)], hospitalization stay over three days before sampling [2.34 (1.71-3.22)], chemotherapy [3.31 (2.22-4.92)], and abdominal surgery [4.82 (3.54-6.55)]. CDI clearly is a problem in Eastern China and has a prevalence of 10.0% in hospitalized patients. Among risk factors for CDI, the advanced age threshold was younger for Chinese patients than that reported in developed countries.