1887

Abstract

Following the first description of a case caused by ribotype 027 in Hungary in 2007, the rapid spread of infection in different hospitals within the country was observed. The aim of this pilot study was to investigate the distribution of different PCR ribotypes among inpatient and outpatient isolates obtained in two geographically different parts of Hungary. One hundred and ninety-two toxigenic isolates collected between 1 October and 1 December 2014 were PCR ribotyped using capillary gel electrophoresis and the database of WEBRIBO (http://webribo.ages.at), which allows the automatic analysis and comparison of capillary-sequencer-based PCR ribotyping data. Altogether, 31 different known ribotypes were found, and 16 isolates showed a novel banding pattern, not included in the current library. Besides the dominance of 027 (33.3 %) among all isolates, there were differences in its presence among isolates obtained from the two regions (45.8 % in the central region and 20.8 % in the south-east region, respectively), whereas the second most prevalent ribotype 036 (19.8 %) was more frequently found among isolates obtained in the south-east region compared with the central region of Hungary (29.1 versus 10.4 %). Similar differences in the spread of different ribotypes, in particular 027, which were found during earlier studies in Hungary may be due to the existing order for admissions of patients to hospitals. We also summarized the changing pattern of PCR ribotypes of Hungarian isolates over time, based on earlier published data.

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2016-10-18
2021-07-24
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References

  1. Barbut F., Mastrantonio P., Delmée M., Brazier J., Kuijper E., Poxton I. European Study Group on Clostridium difficile (ESGCD) 2007; Prospective study of Clostridium difficile infections in Europe with phenotypic and genotypic characterisation of the isolates. Clin Microbiol Infect 13:1048–1057 [View Article][PubMed]
    [Google Scholar]
  2. Bartlett J. G., Chang T. W., Gurwith M., Gorbach S. L., Onderdonk A. B. 1978; Antibiotic-associated pseudomembranous colitis due to toxin-producing clostridia. N Engl J Med 298:531–534 [View Article][PubMed]
    [Google Scholar]
  3. Bauer M. P., Notermans D. W., van Benthem B. H., Brazier J. S., Wilcox M. H., Rupnik M., Monnet D. L., van Dissel J. T., Kuijper E. J. ECDIS Study Group 2011; Clostridium difficile infection in Europe: a hospital-based survey. Lancet 377:63–73 [View Article][PubMed]
    [Google Scholar]
  4. Bidet P., Barbut F., Lalande V., Burghoffer B., Petit J. C. 1999; Development of a new PCR-ribotyping method for Clostridium difficile based on ribosomal RNA gene sequencing. FEMS Microbiol Lett 175:261–266 [View Article][PubMed]
    [Google Scholar]
  5. Brazier J. S., Mulligan M. E., Delmee M., Tabaqchali S. The International Clostridium difficile Study Group 1997; Preliminary findings of the international typing study on Clostridium difficile . Clin Infect Dis 25:S199–S201 [CrossRef]
    [Google Scholar]
  6. Cartwright C. P., Stock F., Beekmann S. E., Williams E. C., Gill V. J. 1995; PCR amplification of rRNA intergenic spacer regions as a method for epidemiologic typing of Clostridium difficile . J Clin Microbiol 33:184–187[PubMed]
    [Google Scholar]
  7. Davies K. A., Longshaw C. M., Davis G. L., Bouza E., Barbut F., Barna Z., Delmée M., Fitzpatrick F., Ivanova K. et al. 2014; Underdiagnosis of Clostridium difficile across Europe: the European, multicentre, prospective, biannual, point-prevalence study of Clostridium difficile infection in hospitalised patients with diarrhoea (EUCLID). Lancet Infect Dis 14:1208–1219 [View Article][PubMed]
    [Google Scholar]
  8. Drabek J., Nyc O., Krutova M., Stovicek J., Matejkova J., Keil R. 2015; Clinical features and characteristics of Clostridium difficile PCR-ribotype 176 infection: results from a 1-year university hospital internal ward study. Ann Clin Microbiol Antimicrob 14:55 [View Article][PubMed]
    [Google Scholar]
  9. Fawley W. N., Knetsch C. W., MacCannell D. R., Harmanus C., Du T., Mulvey M. R., Paulick A., Anderson L., Kuijper E. J., Wilcox M. H. 2015; Development and validation of an internationally-standardized, high-resolution capillary gel-based electrophoresis PCR-ribotyping protocol for Clostridium difficile . PLoS One 10:e0118150 [View Article][PubMed]
    [Google Scholar]
  10. Freeman J., Bauer M. P., Baines S. D., Corver J., Fawley W. N., Goorhuis B., Kuijper E. J., Wilcox M. H. 2010; The changing epidemiology of Clostridium difficile infections. Clin Microbiol Rev 23:529–549 [View Article][PubMed]
    [Google Scholar]
  11. Freeman J., Vernon J., Morris K., Nicholson S., Todhunter S., Longshaw C., Wilcox M. H. Pan-European Longitudinal Surveillance of Antibiotic Resistance among Prevalent Clostridiumdifficile Ribotypes’ Study Group 2015; Pan-European longitudinal surveillance of antibiotic resistance among prevalent Clostridium difficile ribotypes. Clin Microbiol Infect 21:248.e9–248.e16 [View Article]
    [Google Scholar]
  12. Indra A., Huhulescu S., Schneeweis M., Hasenberger P., Kernbichler S., Fiedler A., Wewalka G., Allerberger F., Kuijper E. J. 2008; Characterization of Clostridium difficile isolates using capillary gel electrophoresis-based PCR ribotyping. J Med Microbiol 57:1377–1382 [View Article][PubMed]
    [Google Scholar]
  13. Killgore G., Thompson A., Johnson S., Brazier J., Kuijper E., Pepin J., Frost E. H., Savelkoul P., Nicholson B. et al. 2008; Comparison of seven techniques for typing international epidemic strains of Clostridium difficile: restriction endonuclease analysis, pulsed-field gel electrophoresis, PCR-ribotyping, multilocus sequence typing, multilocus variable-number tandem-repeat analysis, amplified fragment length polymorphism, and surface layer protein A gene sequence typing. J Clin Microbiol 46:431–437 [CrossRef]
    [Google Scholar]
  14. Knetsch C. W., Lawley T. D., Hensgens M. P., Corver J., Wilcox M. W., Kuijper E. J. 2013; Current application and future perspectives of molecular typing methods to study Clostridium difficile infections. Euro Surveill 18:20381[PubMed]
    [Google Scholar]
  15. Krutova M., Matejkova J., Tkadlec J., Nyc O. 2015; Antibiotic profiling of Clostridium difficile ribotype 176 – a multidrug resistant relative to C. difficile ribotype 027. Anaerobe 36:88–90 [View Article][PubMed]
    [Google Scholar]
  16. Nagy E. 2014; Actualities in the epidemiology, diagnostics and therapy of Clostridium difficile infections – a European outlook. Lege Artis Medicinae 24:25–33
    [Google Scholar]
  17. Nyc O., Krutova M., Liskova A., Matejkova J., Drabek J., Kuijper E. J. 2015; The emergence of Clostridium difficile PCR-ribotype 001 in Slovakia. Eur J Clin Microbiol Infect Dis 34:1701–1708 [View Article][PubMed]
    [Google Scholar]
  18. Pituch H., Obuch-Woszczatyński P., Lachowicz D., Wultańska D., Karpiński P., Młynarczyk G., van Dorp S. M., Kuijper E. J. the Polish Clostridium difficile Study Group 2015; Hospital-based Clostridium difficile infection surveillance reveals high proportions of PCR ribotypes 027 and 176 in different areas of Poland, 2011 to 2013. Eurosurveillance 20:30025 [View Article]
    [Google Scholar]
  19. Rafila A., Indra A., Popescu G. A., Wewalka G., Allerberger F., Benea S., Badicut I., Aschbacher R., Huhulescu S. 2014; Occurrence of Clostridium difficile infections due to PCR ribotype 027 in Bucharest Romania. J Infect Dev Ctries 11:694–698
    [Google Scholar]
  20. Rupnik M., Brazier J. S., Duerden B. I., Grabnar M., Stubbs S. L. 2001; Comparison of toxinotyping and PCR ribotyping of Clostridium difficile strains and description of novel toxinotypes. Microbiology 147:439–447 [View Article][PubMed]
    [Google Scholar]
  21. Stubbs S. L., Brazier J. S., O'Neill G. L., Duerden B. I. 1999; PCR targeted to the 16S-23S rRNA gene intergenic spacer region of Clostridium difficile and construction of a library consisting of 116 different PCR ribotypes. J Clin Microbiol 37:461–463[PubMed]
    [Google Scholar]
  22. Terhes G., Urbán E., Sóki J., Hamid K. A., Nagy E. 2004; Community-acquired Clostridium difficile diarrhea caused by binary toxin, toxin A, and toxin B gene-positive isolates in Hungary. J Clin Microbiol 42:4316–4318 [View Article][PubMed]
    [Google Scholar]
  23. Terhes G., Brazier J. S., Urbán E., Sóki J., Nagy E. 2006; Distribution of Clostridium difficile PCR ribotypes in regions of Hungary. J Med Microbiol 55:279–282 [View Article][PubMed]
    [Google Scholar]
  24. Terhes G., Urbán E., Sóki J., Szikra L., Konkoly-Thege M., Vollain M., Nagy E. 2009a; Assessment of changes in the epidemiology of Clostridium difficile isolated from diarrheal patients in Hungary. Anaerobe 15:237–240 [View Article]
    [Google Scholar]
  25. Terhes G., Urbán E., Konkoly-Thege M., Székely É., Brazier J. S., Kuijper E. J., Nagy E. 2009b; First isolation of Clostridium difficile PCR ribotype 027 from a patient with severe persistent diarrhoea in Hungary. Clin Microbiol Infect 15:885–886 [View Article]
    [Google Scholar]
  26. Urbán E., Brazier J. S., Sóki J., Nagy E., Duerden B. I. 2001; PCR ribotyping of clinically important Clostridium difficile strains from Hungary. J Med Microbiol 50:1082–1086 [View Article][PubMed]
    [Google Scholar]
  27. Valiente E., Dawson L. F., Cairns M. D., Stabler R. A., Wren B. W. 2012; Emergence of new PCR ribotypes from the hypervirulent Clostridium difficile 027 lineage. J Med Microbiol 61:49–56 [View Article][PubMed]
    [Google Scholar]
  28. Wüst J., Sullivan N. M., Hardegger U., Wilkins T. D. 1982; Investigation of an outbreak of antibiotic-associated colitis by various typing methods. J Clin Microbiol 16:1096–1101[PubMed]
    [Google Scholar]
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