1887

Abstract

A repetitive-extragenic palindromic PCR (rep-PCR) subtyping method (DiversiLab) in conjunction with ribotyping, toxinotyping and antimicrobial-susceptibility testing was used to detect subtypes within ribotypes 027 and 078. Clinical isolates of ribotypes 027 (toxinotype III) ( = 30) and 078 (toxinotype V) ( = 23) were provided by health-care facilities across the Republic of Ireland over 2 months in 2006 and 1 month in 2009. Ribotype 027 isolates were significantly more related to each other (9 different subtype profiles) when compared to ribotype 078 isolates (14 different profiles) ( = 0.001; cut-off >90 % similarity). Almost half of ribotype 078 isolates (45.5 %) showed no relationship to each other. The clonality of ribotype 027 isolates suggests effective adaptation to the human niche, whereas the considerable genetic diversity within ribotype 078 isolates suggests that they may have originated from a variety of sources. Subtyping correlated well with antimicrobial susceptibility, in particular clindamycin susceptibility for ribotype 027, but diverse antimicrobial-susceptibility profiles were seen in ribotype 078 isolates, even within a single health-care facility. Between 2006 and 2009, a change in the predominant subtype of ribotype 027 was seen, with the recent clone representing half of all ribotype 027 isolates studied. This strain exhibited 89 % similarity to a rep-PCR profile of the North American NAP-1 strain.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.029983-0
2011-08-01
2019-10-18
Loading full text...

Full text loading...

/deliver/fulltext/jmm/60/8/1080.html?itemId=/content/journal/jmm/10.1099/jmm.0.029983-0&mimeType=html&fmt=ahah

References

  1. Bakker D. , Corver J. , Harmanus C. , Goorhuis A. , Keessen E. C. , Fawley W. N. , Wilcox M. H. , Kuijper E. J. . ( 2010; ). Relatedness of human and animal Clostridium difficile PCR ribotype 078 isolates determined on the basis of multilocus variable-number tandem-repeat analysis and tetracycline resistance. . J Clin Microbiol 48:, 3744–3749. [CrossRef].[PubMed]
    [Google Scholar]
  2. Bozdogan B. , Berrezouga L. , Kuo M. S. , Yurek D. A. , Farley K. A. , Stockman B. J. , Leclercq R. . ( 1999; ). A new resistance gene, linB, conferring resistance to lincosamides by nucleotidylation in Enterococcus faecium HM1025. . Antimicrob Agents Chemother 43:, 925–929.[PubMed]
    [Google Scholar]
  3. Brazier J. S. , Raybould R. , Patel B. , Duckworth G. , Pearson A. , Charlett A. , Duerden B. I. . the HPA Regional Microbiology Network ( 2008; ). Distribution and antimicrobial susceptibility patterns of Clostridium difficile PCR ribotypes in English hospitals, 2007–08. . Euro Surveill 13:, pii:19000.[PubMed]
    [Google Scholar]
  4. Burns K. , Morris-Downes M. , Fawley W. N. , Smyth E. , Wilcox M. H. , Fitzpatrick F. . ( 2010a; ). Infection due to C. difficile ribotype 078: first report of cases in the Republic of Ireland. . J Hosp Infect 75:, 287–291. [CrossRef].[PubMed]
    [Google Scholar]
  5. Burns K. , Skally M. , Solomon K. , Scott L. , McDermott S. , O’Flanagan D. , Fanning S. , Kyne L. , Fenelon L. , Fitzpatrick F. . ( 2010b; ). Clostridium difficile infection in the Republic of Ireland: results of a 1-month national surveillance and ribotyping project, March 2009. . Infect Control Hosp Epidemiol 31:, 1085–1087. [CrossRef].[PubMed]
    [Google Scholar]
  6. Climo M. W. , Israel D. S. , Wong E. S. , Williams D. , Coudron P. , Markowitz S. M. . ( 1998; ). Hospital-wide restriction of clindamycin: effect on the incidence of Clostridium difficile-associated diarrhea and cost. . Ann Intern Med 128:, 989–995.[PubMed] [CrossRef]
    [Google Scholar]
  7. CLSI ( 2007; ). Methods for Antimicrobial Susceptibility Testing of Anaerobic Bacteria, approved standard, M11–A7. Wayne, PA:: Clinical and Laboratory Standards Institute;.
    [Google Scholar]
  8. Debast S. B. , Van Leengoed L. A. , Goorhuis A. , Harmanus C. , Kuijper E. J. , Bergwerff A. A. . ( 2009; ). Clostridium difficile PCR ribotype 078 toxinotype V found in diarrhoeal pigs identical to isolates from affected humans. . Environ Microbiol 11:, 505–511. [CrossRef].[PubMed]
    [Google Scholar]
  9. Drudy D. , Goorhuis B. , Bakker D. , Kyne L. , Van den Berg R. , Fenelon L. , Fanning S. , Kuijper E. J. . ( 2008; ). Clindamycin-resistant clone of Clostridium difficile PCR ribotype 027, Europe. . Emerg Infect Dis 14:, 1485–1487. [CrossRef].[PubMed]
    [Google Scholar]
  10. Fawley W. N. , Freeman J. , Wilcox M. H. . ( 2003; ). Evidence to support the existence of subgroups within the UK epidemic Clostridium difficile strain (PCR ribotype 1). . J Hosp Infect 54:, 74–77. [CrossRef].[PubMed]
    [Google Scholar]
  11. Fawley W. N. , Freeman J. , Smith C. , Harmanus C. , Van den Berg R. J. , Kuijper E. J. , Wilcox M. H. . ( 2008; ). Use of highly discriminatory fingerprinting to analyze clusters of Clostridium difficile infection cases due to epidemic ribotype 027 strains. . J Clin Microbiol 46:, 954–960. [CrossRef].[PubMed]
    [Google Scholar]
  12. Goorhuis A. , Bakker D. , Corver J. , Debast S. B. , Harmanus C. , Notermans D. W. , Bergwerff A. A. , Dekker F. W. , Kuijper E. J. . ( 2008a; ). Emergence of Clostridium difficile infection due to a new hypervirulent strain, polymerase chain reaction ribotype 078. . Clin Infect Dis 47:, 1162–1170. [CrossRef].[PubMed]
    [Google Scholar]
  13. Goorhuis A. , Debast S. B. , Van Leengoed L. A. M. G. , Harmanus C. , Notermans D. W. , Bergwerff A. A. , Kuijper E. J. . ( 2008b; ). Clostridium difficile PCR ribotype 078: an emerging strain in humans and in pigs?. J Clin Microbiol 46:, 1157–1158. [CrossRef].[PubMed]
    [Google Scholar]
  14. Healy M. , Huong J. , Bittner T. , Lising M. , Frye S. , Raza S. , Schrock R. , Manry J. , Renwick A. et al. ( 2005; ). Microbial DNA typing by automated repetitive-sequence-based PCR. . J Clin Microbiol 43:, 199–207. [CrossRef].[PubMed]
    [Google Scholar]
  15. Hensgens M. P. , Goorhuis A. , Notermans D. W. , Van Benthem B. H. , Kuijper E. J. . ( 2009; ). Decrease of hypervirulent Clostridium difficile PCR ribotype 027 in the Netherlands. . Euro Surveill 14:, pii:19402.[PubMed]
    [Google Scholar]
  16. HPSC–HSE ( 2008; ). Consumption of Antibiotics in Public Acute Hospitals in Ireland, 2008. Dublin:: Health Protection Surveillance Centre and Health Service Executive;. http://www.hpsc.ie/hpsc/A-Z/MicrobiologyAntimicrobialResistance/EuropeanSurveillanceofAntimicrobialConsumptionESAC/SurveillanceReports/File,3889,en.pdf
    [Google Scholar]
  17. Jhung M. A. , Thompson A. D. , Killgore G. E. , Zukowski W. E. , Songer G. , Warny M. , Johnson S. , Gerding D. N. , McDonald L. C. , Limbago B. M. . ( 2008; ). Toxinotype V Clostridium difficile in humans and food animals. . Emerg Infect Dis 14:, 1039–1045. [CrossRef].[PubMed]
    [Google Scholar]
  18. Johnson S. , Samore M. H. , Farrow K. A. , Killgore G. E. , Tenover F. C. , Lyras D. , Rood J. I. , DeGirolami P. , Baltch A. L. et al. ( 1999; ). Epidemics of diarrhea caused by a clindamycin-resistant strain of Clostridium difficile in four hospitals. . N Engl J Med 341:, 1645–1651. [CrossRef].[PubMed]
    [Google Scholar]
  19. Keel K. , Brazier J. S. , Post K. W. , Weese S. , Songer J. G. . ( 2007; ). Prevalence of PCR ribotypes among Clostridium difficile isolates from pigs, calves, and other species. . J Clin Microbiol 45:, 1963–1964. [CrossRef].[PubMed]
    [Google Scholar]
  20. 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].[PubMed]
    [Google Scholar]
  21. Kuijper E. J. , Coignard B. , Tüll P. . on behalf of the ESCMID Study Group for Clostridium difficile (ESGCD) EU Member States the European Centre for Disease Prevention and Control (ECDC) ( 2006; ). Emergence of Clostridium difficile-associated disease in North America and Europe. . Clin Microbiol Infect 12: (Suppl. 6), 2–18. [CrossRef].[PubMed]
    [Google Scholar]
  22. Kuijper E. J. , Coignard B. , Brazier J. S. , Suetens C. , Drudy D. , Wiuff C. , Pituch H. , Reichert P. , Schneider F. et al. ( 2007; ). Update of Clostridium difficile-associated disease due to PCR ribotype 027 in Europe. . Euro Surveill 12:, E1–E2.[PubMed]
    [Google Scholar]
  23. Kuijper E. J. , Barbut F. , Brazier J. S. , Kleinkauf N. , Eckmanns T. , Lambert M. L. , Drudy D. , Fitzpatrick F. , Wiuff C. et al. ( 2008; ). Update of Clostridium difficile infection due to PCR ribotype 027 in Europe, 2008. . Euro Surveill 13:, pii:18942.[PubMed]
    [Google Scholar]
  24. Kuijper E. J. , Van den Berg R. J. , Brazier J. S. . ( 2009; ). Comparison of molecular typing methods applied to Clostridium difficile . . Methods Mol Biol 551:, 159–171. [CrossRef]
    [Google Scholar]
  25. Lin Y. C. , Huang Y. T. , Tsai P. J. , Lee T. F. , Lee N. Y. , Liao C. H. , Lin S. Y. , Ko W. C. , Hsueh P. R. . ( 2011; ). Antimicrobial susceptibilities and molecular epidemiology of clinical isolates of Clostridium difficile in Taiwan. . Antimicrob Agents Chemother 55:, 1701–1705. [CrossRef].[PubMed]
    [Google Scholar]
  26. McDonald L. C. , Killgore G. E. , Thompson A. , Owens R. C. Jr , Kazakova S. V. , Sambol S. P. , Johnson S. , Gerding D. N. . ( 2005; ). An epidemic, toxin gene-variant strain of Clostridium difficile . . N Engl J Med 353:, 2433–2441. [CrossRef].[PubMed]
    [Google Scholar]
  27. Montagnani F. , Zanchi A. , Stolzuoli L. , Croci L. , Cellesi C. . ( 2007; ). Clindamycin-resistant Streptococcus pneumoniae . . Emerg Infect Dis 13:, 801–802.[PubMed] [CrossRef]
    [Google Scholar]
  28. Northey G. , Gal M. , Rahmati A. , Brazier J. S. . ( 2005; ). Subtyping of Clostridium difficile PCR ribotype 001 by REP-PCR and PFGE. . J Med Microbiol 54:, 543–547. [CrossRef].[PubMed]
    [Google Scholar]
  29. Notermans D. W. , Van der Kooi T. I. , Goorhuis A. , Debast S. B. , Van Benthem B. H. , Kuijper E. J. . ( 2008; ). [Epidemiology of Clostridium difficile PCR ribotype 027 in the Netherlands 2005–present and the emergence of other subtypes]. . Ned Tijdschr Geneeskd 152:, 1937–1940 (in Dutch).[PubMed]
    [Google Scholar]
  30. Pasanen T. , Kotila S. M. , Horsma J. , Virolainen A. , Jalava J. , Ibrahem S. , Antikainen J. , Mero S. , Tarkka E. et al. ( 2011; ). Comparison of repetitive extragenic palindromic sequence-based PCR with PCR ribotyping and pulsed-field gel electrophoresis in studying the clonality of Clostridium difficile . . Clin Microbiol Infect 17:, 166–175. [CrossRef].[PubMed]
    [Google Scholar]
  31. Pear S. M. , Williamson T. H. , Bettin K. M. , Gerding D. N. , Galgiani J. N. . ( 1994; ). Decrease in nosocomial Clostridium difficile-associated diarrhea by restricting clindamycin use. . Ann Intern Med 120:, 272–277.[PubMed] [CrossRef]
    [Google Scholar]
  32. Rahmati A. , Gal M. , Northey G. , Brazier J. S. . ( 2005; ). Subtyping of Clostridium difficile polymerase chain reaction (PCR) ribotype 001 by repetitive extragenic palindromic PCR genomic fingerprinting. . J Hosp Infect 60:, 56–60. [CrossRef].[PubMed]
    [Google Scholar]
  33. Rupnik M. , Avesani V. , Janc M. , Von Eichel-Streiber C. , Delmée M. . ( 1998; ). A novel toxinotyping scheme and correlation of toxinotypes with serogroups of Clostridium difficile isolates. . J Clin Microbiol 36:, 2240–2247.[PubMed]
    [Google Scholar]
  34. Rupnik M. , Widmer A. , Zimmermann O. , Eckert C. , Barbut F. . ( 2008; ). Clostridium difficile toxinotype V, ribotype 078, in animals and humans. . J Clin Microbiol 46:, 2146. [CrossRef].[PubMed]
    [Google Scholar]
  35. Smith A. . ( 2005; ). Outbreak of Clostridium difficile infection in an English hospital linked to hypertoxin-producing strains in Canada and the US. . Euro Surveill 10:, E050630.2.[PubMed]
    [Google Scholar]
  36. Spigaglia P. , Mastrantonio P. . ( 2003; ). Evaluation of repetitive element sequence-based PCR as a molecular typing method for Clostridium difficile . . J Clin Microbiol 41:, 2454–2457. [CrossRef].[PubMed]
    [Google Scholar]
  37. 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]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.029983-0
Loading
/content/journal/jmm/10.1099/jmm.0.029983-0
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error