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Investigation of toxin gene diversity, molecular epidemiology, and antimicrobial resistance of Clostridium difficile isolated from 12 hospitals in South Korea.
Korean J Lab Med. 2010 Oct; 30(5):491-7.KJ

Abstract

BACKGROUND

Clostridium difficile is a major cause of antibiotic-associated diarrhea. The objective of this study was to characterize clinical isolates of C. difficile obtained from various regions in Korea with regard to their toxin status, molecular type, and antimicrobial susceptibility.

METHODS

We analyzed a total of 408 C. difficile isolates obtained between 2006 and 2008 from 408 patients with diarrhea in 12 South Korean teaching hospitals. C. difficile toxin genes tcdA, tcdB, cdtA, and cdtB were detected by PCR. Molecular genotyping was performed by PCR ribotyping. Antimicrobial susceptibilities of the 120 C. difficile isolates were assessed by agar dilution methods.

RESULTS

Among 337 toxigenic isolates, 105 were toxin A-negative and toxin B-positive (A(-)B(+)) and 29 were binary toxin-producing strains. PCR ribotyping showed 50 different ribotype patterns. The 5 most frequently occurring ribotypes comprised 62.0% of all identified ribotypes. No isolate was susceptible to cefoxitin, and all except 1 were susceptible to piperacillin and piperacillin-tazobactam. The resistance rates of isolates to imipenem, cefotetan, moxifloxacin, ampicillin, and clindamycin were 25%, 34%, 42%, 51%, and 60%, respectively. The isolates showed no resistance to metronidazole or vancomycin.

CONCLUSIONS

This is the first nationwide study on the toxin status, including PCR ribotyping and antimicrobial resistance, of C. difficile isolates in Korea. The prevalence of A-B+ strains was 25.7%, much higher than that reported from other countries. Binary toxin-producing strains accounted for 7.1% of all strains, which was not rare in Korea. The most prevalent ribotype was ribotype 017, and all A-B+ strains showed this pattern. We did not isolate strains with decreased susceptibility to metronidazole or vancomycin.

Authors+Show Affiliations

Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20890081

Citation

Kim, Heejung, et al. "Investigation of Toxin Gene Diversity, Molecular Epidemiology, and Antimicrobial Resistance of Clostridium Difficile Isolated From 12 Hospitals in South Korea." The Korean Journal of Laboratory Medicine, vol. 30, no. 5, 2010, pp. 491-7.
Kim H, Jeong SH, Roh KH, et al. Investigation of toxin gene diversity, molecular epidemiology, and antimicrobial resistance of Clostridium difficile isolated from 12 hospitals in South Korea. Korean J Lab Med. 2010;30(5):491-7.
Kim, H., Jeong, S. H., Roh, K. H., Hong, S. G., Kim, J. W., Shin, M. G., Kim, M. N., Shin, H. B., Uh, Y., Lee, H., & Lee, K. (2010). Investigation of toxin gene diversity, molecular epidemiology, and antimicrobial resistance of Clostridium difficile isolated from 12 hospitals in South Korea. The Korean Journal of Laboratory Medicine, 30(5), 491-7. https://doi.org/10.3343/kjlm.2010.30.5.491
Kim H, et al. Investigation of Toxin Gene Diversity, Molecular Epidemiology, and Antimicrobial Resistance of Clostridium Difficile Isolated From 12 Hospitals in South Korea. Korean J Lab Med. 2010;30(5):491-7. PubMed PMID: 20890081.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Investigation of toxin gene diversity, molecular epidemiology, and antimicrobial resistance of Clostridium difficile isolated from 12 hospitals in South Korea. AU - Kim,Heejung, AU - Jeong,Seok Hoon, AU - Roh,Kyoung Ho, AU - Hong,Seong Geun, AU - Kim,Jong Wan, AU - Shin,Myung-Geun, AU - Kim,Mi-Na, AU - Shin,Hee Bong, AU - Uh,Young, AU - Lee,Hyukmin, AU - Lee,Kyungwon, PY - 2010/10/5/entrez PY - 2010/10/5/pubmed PY - 2011/2/18/medline SP - 491 EP - 7 JF - The Korean journal of laboratory medicine JO - Korean J Lab Med VL - 30 IS - 5 N2 - BACKGROUND: Clostridium difficile is a major cause of antibiotic-associated diarrhea. The objective of this study was to characterize clinical isolates of C. difficile obtained from various regions in Korea with regard to their toxin status, molecular type, and antimicrobial susceptibility. METHODS: We analyzed a total of 408 C. difficile isolates obtained between 2006 and 2008 from 408 patients with diarrhea in 12 South Korean teaching hospitals. C. difficile toxin genes tcdA, tcdB, cdtA, and cdtB were detected by PCR. Molecular genotyping was performed by PCR ribotyping. Antimicrobial susceptibilities of the 120 C. difficile isolates were assessed by agar dilution methods. RESULTS: Among 337 toxigenic isolates, 105 were toxin A-negative and toxin B-positive (A(-)B(+)) and 29 were binary toxin-producing strains. PCR ribotyping showed 50 different ribotype patterns. The 5 most frequently occurring ribotypes comprised 62.0% of all identified ribotypes. No isolate was susceptible to cefoxitin, and all except 1 were susceptible to piperacillin and piperacillin-tazobactam. The resistance rates of isolates to imipenem, cefotetan, moxifloxacin, ampicillin, and clindamycin were 25%, 34%, 42%, 51%, and 60%, respectively. The isolates showed no resistance to metronidazole or vancomycin. CONCLUSIONS: This is the first nationwide study on the toxin status, including PCR ribotyping and antimicrobial resistance, of C. difficile isolates in Korea. The prevalence of A-B+ strains was 25.7%, much higher than that reported from other countries. Binary toxin-producing strains accounted for 7.1% of all strains, which was not rare in Korea. The most prevalent ribotype was ribotype 017, and all A-B+ strains showed this pattern. We did not isolate strains with decreased susceptibility to metronidazole or vancomycin. SN - 1598-6535 UR - https://www.unboundmedicine.com/medline/citation/20890081/Investigation_of_toxin_gene_diversity_molecular_epidemiology_and_antimicrobial_resistance_of_Clostridium_difficile_isolated_from_12_hospitals_in_South_Korea_ L2 - http://www.annlabmed.org/journal/viewJournal.html?year=2010&vol=30&page=491 DB - PRIME DP - Unbound Medicine ER -