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A nationwide study of molecular epidemiology and antimicrobial susceptibility of Clostridioides difficile in South Korea.
Anaerobe. 2019 Dec; 60:102106.A

Abstract

The molecular epidemiology and antimicrobial resistance of Clostridioides difficile were studied in South Korea in 2017 as part of a National Surveillance System. From February to May 2017, all non-duplicate isolates of C. difficile were recovered from patients who were suspected to have C. difficile infection and collected from 6 referral hospitals representing the 6 regions in South Korea. We performed PCRs for the toxin gene, PCR ribotyping, multilocus sequence typing (MLST), antimicrobial susceptibility testing by agar dilution according to the recommendations of the CLSI and detection of antimicrobial resistance genes such as ermB, catD, tetM, vanZ and nimR by PCR. Of 331 C. difficile isolates, 257 (77.6%) were toxigenic and the prevalence of strains producing binary toxin (CDT) was 5.1% (13/257). A total of 52 different ribotype (RT) patterns were found. RT018 was the most common (25.1% of all isolates), and RT014/020, RT002 and RT012 were also common. RT010 was most common non-toxigenic strain. MLST analysis of randomly selected 72 C. difficile isolates identified 46 sequence types (STs), of which three were new and not in the PubMLST library. There was a good correlation between MLST and RT as following: ST1 (RT027), ST8 (RT002), ST11 (RT078), ST17 (RT018), ST35 (RT046), ST37 (RT017), ST42 (RT106), ST53 (RT103), ST81 (RT369), and ST99 (RT070). All toxigenic isolates were susceptible to metronidazole and vancomycin (MIC ≤ 2 mg/L). For rifaximin, 24% of toxigenic isolates were resistant. Of randomly selected 106 toxigenic isolates, resistance rates for ampicillin, cefotetan, clindamycin, imipenem, chloramphenicol, tetracycline, and moxifloxacin were 48%, 46%, 64%, 54%, 0%, 6% and 52% respectively and frequencies of various resistance genes were 62.3% for ermB, 0.9% catD and 10.4% tetM. RTs018, 002, 017 and 369 showed high MICs to various antimicrobial agents and multi-drug resistance was common also.

Authors+Show Affiliations

Department of Laboratory Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, South Korea.Department of Laboratory Medicine, Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea. Electronic address: hjkim12@yuhs.ac.Department of Laboratory Medicine, Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea.Department of Laboratory Medicine, Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea.Department of Laboratory Medicine, Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea.Inje Universtiy Busan Paik Hospital, Busan, South Korea.National Health Insurance Service Ilsan Hospital, Goyang, South Korea.Chonnam National University Medical School, Gwangju, South Korea.Chungbuk National University College of Medicine, Cheongju, South Korea.Yonsei University Wonju College of Medicine, Wonju, South Korea.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31655214

Citation

Byun, Jung-Hyun, et al. "A Nationwide Study of Molecular Epidemiology and Antimicrobial Susceptibility of Clostridioides Difficile in South Korea." Anaerobe, vol. 60, 2019, p. 102106.
Byun JH, Kim H, Kim JL, et al. A nationwide study of molecular epidemiology and antimicrobial susceptibility of Clostridioides difficile in South Korea. Anaerobe. 2019;60:102106.
Byun, J. H., Kim, H., Kim, J. L., Kim, D., Jeong, S. H., Shin, J. H., Kim, Y. A., Shin, J. H., Shin, K. S., & Uh, Y. (2019). A nationwide study of molecular epidemiology and antimicrobial susceptibility of Clostridioides difficile in South Korea. Anaerobe, 60, 102106. https://doi.org/10.1016/j.anaerobe.2019.102106
Byun JH, et al. A Nationwide Study of Molecular Epidemiology and Antimicrobial Susceptibility of Clostridioides Difficile in South Korea. Anaerobe. 2019;60:102106. PubMed PMID: 31655214.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A nationwide study of molecular epidemiology and antimicrobial susceptibility of Clostridioides difficile in South Korea. AU - Byun,Jung-Hyun, AU - Kim,Heejung, AU - Kim,Jung Lim, AU - Kim,Dokyun, AU - Jeong,Seok Hoon, AU - Shin,Jeong Hwan, AU - Kim,Young Ah, AU - Shin,Jong Hee, AU - Shin,Kyeong Seob, AU - Uh,Young, Y1 - 2019/10/23/ PY - 2019/02/20/received PY - 2019/09/09/revised PY - 2019/10/01/accepted PY - 2019/10/28/pubmed PY - 2020/4/21/medline PY - 2019/10/27/entrez KW - Antimicrobial resistance KW - Clostridioides difficile KW - Clostridium difficile KW - MLST KW - National surveillance KW - Ribotype KW - South Korea KW - Toxin SP - 102106 EP - 102106 JF - Anaerobe JO - Anaerobe VL - 60 N2 - The molecular epidemiology and antimicrobial resistance of Clostridioides difficile were studied in South Korea in 2017 as part of a National Surveillance System. From February to May 2017, all non-duplicate isolates of C. difficile were recovered from patients who were suspected to have C. difficile infection and collected from 6 referral hospitals representing the 6 regions in South Korea. We performed PCRs for the toxin gene, PCR ribotyping, multilocus sequence typing (MLST), antimicrobial susceptibility testing by agar dilution according to the recommendations of the CLSI and detection of antimicrobial resistance genes such as ermB, catD, tetM, vanZ and nimR by PCR. Of 331 C. difficile isolates, 257 (77.6%) were toxigenic and the prevalence of strains producing binary toxin (CDT) was 5.1% (13/257). A total of 52 different ribotype (RT) patterns were found. RT018 was the most common (25.1% of all isolates), and RT014/020, RT002 and RT012 were also common. RT010 was most common non-toxigenic strain. MLST analysis of randomly selected 72 C. difficile isolates identified 46 sequence types (STs), of which three were new and not in the PubMLST library. There was a good correlation between MLST and RT as following: ST1 (RT027), ST8 (RT002), ST11 (RT078), ST17 (RT018), ST35 (RT046), ST37 (RT017), ST42 (RT106), ST53 (RT103), ST81 (RT369), and ST99 (RT070). All toxigenic isolates were susceptible to metronidazole and vancomycin (MIC ≤ 2 mg/L). For rifaximin, 24% of toxigenic isolates were resistant. Of randomly selected 106 toxigenic isolates, resistance rates for ampicillin, cefotetan, clindamycin, imipenem, chloramphenicol, tetracycline, and moxifloxacin were 48%, 46%, 64%, 54%, 0%, 6% and 52% respectively and frequencies of various resistance genes were 62.3% for ermB, 0.9% catD and 10.4% tetM. RTs018, 002, 017 and 369 showed high MICs to various antimicrobial agents and multi-drug resistance was common also. SN - 1095-8274 UR - https://www.unboundmedicine.com/medline/citation/31655214/A_nationwide_study_of_molecular_epidemiology_and_antimicrobial_susceptibility_of_Clostridioides_difficile_in_South_Korea L2 - https://linkinghub.elsevier.com/retrieve/pii/S1075-9964(19)30178-7 DB - PRIME DP - Unbound Medicine ER -