Molecular characteristics, clonal transmission, and risk factors of Clostridioides difficile among hospitalized patients in a tertiary hospital in Ningbo, China
BackgroundNosocomial transmission of Clostridioides difficile infection (CDI) has been documented in Ningbo, China. However, data on molecular characteristics, clonal transmission, and risk factors of CDI in this region remain limited.MethodsA cross-sectional study enrolled hospitalized patients wit...
Saved in:
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2024-12-01
|
| Series: | Frontiers in Microbiology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fmicb.2024.1507128/full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850180560449699840 |
|---|---|
| author | Liqing Hu Shan Lin Shan Lin Shan Lin Meng Zhang Meng Zhang Mengting Cai Mengting Cai Yuhang Shen Yuhang Shen Yuhang Shen Peng Zeng Peng Zeng Xiaojun Song Qiao Bian Jina Gu Yun Luo Yu Chen Yu Chen Dazhi Jin Dazhi Jin Dazhi Jin |
| author_facet | Liqing Hu Shan Lin Shan Lin Shan Lin Meng Zhang Meng Zhang Mengting Cai Mengting Cai Yuhang Shen Yuhang Shen Yuhang Shen Peng Zeng Peng Zeng Xiaojun Song Qiao Bian Jina Gu Yun Luo Yu Chen Yu Chen Dazhi Jin Dazhi Jin Dazhi Jin |
| author_sort | Liqing Hu |
| collection | DOAJ |
| description | BackgroundNosocomial transmission of Clostridioides difficile infection (CDI) has been documented in Ningbo, China. However, data on molecular characteristics, clonal transmission, and risk factors of CDI in this region remain limited.MethodsA cross-sectional study enrolled hospitalized patients with diarrhea during September to November 2021. Stool samples from all patients were tested for C. difficile, and isolated strains underwent toxin gene identification, genotyping, and antibiotic susceptibility testing. Whole-genome sequencing and epidemiological variables were analyzed in patients infected with C. difficile strains of the same sequence types (STs) to identify nosocomial transmission and risk factors for CDI.ResultsOf the 907 investigated patients, 115 (12.7%) had microbiologically proven CDI, as their diarrhea was associated with toxigenic C. difficile strains, which comprised 106 A+B+CDT−, 3 A−B+CDT−, and 6 A+B+CDT+. Predominant genotypes (ST2, ST3, ST35, and ST54) exhibited distinct antibiotic resistance patterns. ST54 strains showed higher resistance to erythromycin (100%) but lower resistance to moxifloxacin (18.2%) and gatifloxacin (18.2%) (χ2 = 10.24–16.65, p < 0.05). ST35 strains exhibited higher resistance to ciprofloxacin (66.7%) and tetracycline (33.3%) than other STs (χ2 = 13.30–20.19, p < 0.05). Genomic and epidemiological analysis revealed two nosocomial clonal transmission events caused by 5 ST35 strains (with ≤2 single nucleotide polymorphism differences), elucidating clonal transmission among different floors and buildings within the hospital. Prolonged hospitalization (> 10 days) (odds ratio [95% confidence interval], 1.76 [1.05–2.93]) and penicillin-class antibiotics (1.69 [1.11–2.58]) were risk factors for CDI, with the latter being an independent risk factor (1.57 [1.02–2.42]). For C. difficile ST35 infection, intensive care unit (12.00 [2.77–52.05]) and neurology departments (8.08 [1.46–44.65]) admissions were risk factors, with the latter as an independent risk factor (1.56 [1.01–2.40]).ConclusionMultiple C. difficile genotypes with varied antibiotic resistance patterns circulated in Ningbo, with ST35 causing nosocomial clonal transmission among different floors and buildings within the hospital. These findings and the identified risk factors necessitate enhanced surveillance and infection control in the region. |
| format | Article |
| id | doaj-art-1066fa8bad094893b3a080a97adb0b4c |
| institution | OA Journals |
| issn | 1664-302X |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Microbiology |
| spelling | doaj-art-1066fa8bad094893b3a080a97adb0b4c2025-08-20T02:18:09ZengFrontiers Media S.A.Frontiers in Microbiology1664-302X2024-12-011510.3389/fmicb.2024.15071281507128Molecular characteristics, clonal transmission, and risk factors of Clostridioides difficile among hospitalized patients in a tertiary hospital in Ningbo, ChinaLiqing Hu0Shan Lin1Shan Lin2Shan Lin3Meng Zhang4Meng Zhang5Mengting Cai6Mengting Cai7Yuhang Shen8Yuhang Shen9Yuhang Shen10Peng Zeng11Peng Zeng12Xiaojun Song13Qiao Bian14Jina Gu15Yun Luo16Yu Chen17Yu Chen18Dazhi Jin19Dazhi Jin20Dazhi Jin21Department of Laboratory Medicine, The First Affiliated Hospital of Ningbo University, Ningbo, ChinaTEDA Institute of Biological Sciences and Biotechnology, Nankai University, Tianjin, ChinaSchool of Laboratory Medicine, Hangzhou Medical College, Hangzhou, ChinaKey Laboratory of Biomarkers and In Vitro Diagnosis Translation of Zhejiang Province, Hangzhou, ChinaSchool of Laboratory Medicine, Hangzhou Medical College, Hangzhou, ChinaKey Laboratory of Biomarkers and In Vitro Diagnosis Translation of Zhejiang Province, Hangzhou, ChinaSchool of Laboratory Medicine, Hangzhou Medical College, Hangzhou, ChinaKey Laboratory of Biomarkers and In Vitro Diagnosis Translation of Zhejiang Province, Hangzhou, ChinaSchool of Laboratory Medicine, Hangzhou Medical College, Hangzhou, ChinaKey Laboratory of Biomarkers and In Vitro Diagnosis Translation of Zhejiang Province, Hangzhou, ChinaInstitute of Ageing Research, School of Basic Medical Sciences, Hangzhou Normal University, Hangzhou, ChinaSchool of Laboratory Medicine, Hangzhou Medical College, Hangzhou, ChinaDepartment of Clinical Laboratory, Yuedong Hospital, The Third Affiliated Hospital of Sun Yat-sen University, Meizhou, ChinaLaboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People’s Hospital, Hangzhou Medical College, Hangzhou, ChinaZhejiang Provincial Center for Disease Control and Prevention, Hangzhou, ChinaDepartment of Infectious Diseases, Ningbo No.2 Hospital, Ningbo, China0School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW, AustraliaSchool of Laboratory Medicine, Hangzhou Medical College, Hangzhou, ChinaKey Laboratory of Biomarkers and In Vitro Diagnosis Translation of Zhejiang Province, Hangzhou, ChinaSchool of Laboratory Medicine, Hangzhou Medical College, Hangzhou, ChinaKey Laboratory of Biomarkers and In Vitro Diagnosis Translation of Zhejiang Province, Hangzhou, ChinaLaboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People’s Hospital, Hangzhou Medical College, Hangzhou, ChinaBackgroundNosocomial transmission of Clostridioides difficile infection (CDI) has been documented in Ningbo, China. However, data on molecular characteristics, clonal transmission, and risk factors of CDI in this region remain limited.MethodsA cross-sectional study enrolled hospitalized patients with diarrhea during September to November 2021. Stool samples from all patients were tested for C. difficile, and isolated strains underwent toxin gene identification, genotyping, and antibiotic susceptibility testing. Whole-genome sequencing and epidemiological variables were analyzed in patients infected with C. difficile strains of the same sequence types (STs) to identify nosocomial transmission and risk factors for CDI.ResultsOf the 907 investigated patients, 115 (12.7%) had microbiologically proven CDI, as their diarrhea was associated with toxigenic C. difficile strains, which comprised 106 A+B+CDT−, 3 A−B+CDT−, and 6 A+B+CDT+. Predominant genotypes (ST2, ST3, ST35, and ST54) exhibited distinct antibiotic resistance patterns. ST54 strains showed higher resistance to erythromycin (100%) but lower resistance to moxifloxacin (18.2%) and gatifloxacin (18.2%) (χ2 = 10.24–16.65, p < 0.05). ST35 strains exhibited higher resistance to ciprofloxacin (66.7%) and tetracycline (33.3%) than other STs (χ2 = 13.30–20.19, p < 0.05). Genomic and epidemiological analysis revealed two nosocomial clonal transmission events caused by 5 ST35 strains (with ≤2 single nucleotide polymorphism differences), elucidating clonal transmission among different floors and buildings within the hospital. Prolonged hospitalization (> 10 days) (odds ratio [95% confidence interval], 1.76 [1.05–2.93]) and penicillin-class antibiotics (1.69 [1.11–2.58]) were risk factors for CDI, with the latter being an independent risk factor (1.57 [1.02–2.42]). For C. difficile ST35 infection, intensive care unit (12.00 [2.77–52.05]) and neurology departments (8.08 [1.46–44.65]) admissions were risk factors, with the latter as an independent risk factor (1.56 [1.01–2.40]).ConclusionMultiple C. difficile genotypes with varied antibiotic resistance patterns circulated in Ningbo, with ST35 causing nosocomial clonal transmission among different floors and buildings within the hospital. These findings and the identified risk factors necessitate enhanced surveillance and infection control in the region.https://www.frontiersin.org/articles/10.3389/fmicb.2024.1507128/fullClostridioides difficile infectionmolecular characteristicswhole-genome sequencingclonal transmissionrisk factors |
| spellingShingle | Liqing Hu Shan Lin Shan Lin Shan Lin Meng Zhang Meng Zhang Mengting Cai Mengting Cai Yuhang Shen Yuhang Shen Yuhang Shen Peng Zeng Peng Zeng Xiaojun Song Qiao Bian Jina Gu Yun Luo Yu Chen Yu Chen Dazhi Jin Dazhi Jin Dazhi Jin Molecular characteristics, clonal transmission, and risk factors of Clostridioides difficile among hospitalized patients in a tertiary hospital in Ningbo, China Frontiers in Microbiology Clostridioides difficile infection molecular characteristics whole-genome sequencing clonal transmission risk factors |
| title | Molecular characteristics, clonal transmission, and risk factors of Clostridioides difficile among hospitalized patients in a tertiary hospital in Ningbo, China |
| title_full | Molecular characteristics, clonal transmission, and risk factors of Clostridioides difficile among hospitalized patients in a tertiary hospital in Ningbo, China |
| title_fullStr | Molecular characteristics, clonal transmission, and risk factors of Clostridioides difficile among hospitalized patients in a tertiary hospital in Ningbo, China |
| title_full_unstemmed | Molecular characteristics, clonal transmission, and risk factors of Clostridioides difficile among hospitalized patients in a tertiary hospital in Ningbo, China |
| title_short | Molecular characteristics, clonal transmission, and risk factors of Clostridioides difficile among hospitalized patients in a tertiary hospital in Ningbo, China |
| title_sort | molecular characteristics clonal transmission and risk factors of clostridioides difficile among hospitalized patients in a tertiary hospital in ningbo china |
| topic | Clostridioides difficile infection molecular characteristics whole-genome sequencing clonal transmission risk factors |
| url | https://www.frontiersin.org/articles/10.3389/fmicb.2024.1507128/full |
| work_keys_str_mv | AT liqinghu molecularcharacteristicsclonaltransmissionandriskfactorsofclostridioidesdifficileamonghospitalizedpatientsinatertiaryhospitalinningbochina AT shanlin molecularcharacteristicsclonaltransmissionandriskfactorsofclostridioidesdifficileamonghospitalizedpatientsinatertiaryhospitalinningbochina AT shanlin molecularcharacteristicsclonaltransmissionandriskfactorsofclostridioidesdifficileamonghospitalizedpatientsinatertiaryhospitalinningbochina AT shanlin molecularcharacteristicsclonaltransmissionandriskfactorsofclostridioidesdifficileamonghospitalizedpatientsinatertiaryhospitalinningbochina AT mengzhang molecularcharacteristicsclonaltransmissionandriskfactorsofclostridioidesdifficileamonghospitalizedpatientsinatertiaryhospitalinningbochina AT mengzhang molecularcharacteristicsclonaltransmissionandriskfactorsofclostridioidesdifficileamonghospitalizedpatientsinatertiaryhospitalinningbochina AT mengtingcai molecularcharacteristicsclonaltransmissionandriskfactorsofclostridioidesdifficileamonghospitalizedpatientsinatertiaryhospitalinningbochina AT mengtingcai molecularcharacteristicsclonaltransmissionandriskfactorsofclostridioidesdifficileamonghospitalizedpatientsinatertiaryhospitalinningbochina AT yuhangshen molecularcharacteristicsclonaltransmissionandriskfactorsofclostridioidesdifficileamonghospitalizedpatientsinatertiaryhospitalinningbochina AT yuhangshen molecularcharacteristicsclonaltransmissionandriskfactorsofclostridioidesdifficileamonghospitalizedpatientsinatertiaryhospitalinningbochina AT yuhangshen molecularcharacteristicsclonaltransmissionandriskfactorsofclostridioidesdifficileamonghospitalizedpatientsinatertiaryhospitalinningbochina AT pengzeng molecularcharacteristicsclonaltransmissionandriskfactorsofclostridioidesdifficileamonghospitalizedpatientsinatertiaryhospitalinningbochina AT pengzeng molecularcharacteristicsclonaltransmissionandriskfactorsofclostridioidesdifficileamonghospitalizedpatientsinatertiaryhospitalinningbochina AT xiaojunsong molecularcharacteristicsclonaltransmissionandriskfactorsofclostridioidesdifficileamonghospitalizedpatientsinatertiaryhospitalinningbochina AT qiaobian molecularcharacteristicsclonaltransmissionandriskfactorsofclostridioidesdifficileamonghospitalizedpatientsinatertiaryhospitalinningbochina AT jinagu molecularcharacteristicsclonaltransmissionandriskfactorsofclostridioidesdifficileamonghospitalizedpatientsinatertiaryhospitalinningbochina AT yunluo molecularcharacteristicsclonaltransmissionandriskfactorsofclostridioidesdifficileamonghospitalizedpatientsinatertiaryhospitalinningbochina AT yuchen molecularcharacteristicsclonaltransmissionandriskfactorsofclostridioidesdifficileamonghospitalizedpatientsinatertiaryhospitalinningbochina AT yuchen molecularcharacteristicsclonaltransmissionandriskfactorsofclostridioidesdifficileamonghospitalizedpatientsinatertiaryhospitalinningbochina AT dazhijin molecularcharacteristicsclonaltransmissionandriskfactorsofclostridioidesdifficileamonghospitalizedpatientsinatertiaryhospitalinningbochina AT dazhijin molecularcharacteristicsclonaltransmissionandriskfactorsofclostridioidesdifficileamonghospitalizedpatientsinatertiaryhospitalinningbochina AT dazhijin molecularcharacteristicsclonaltransmissionandriskfactorsofclostridioidesdifficileamonghospitalizedpatientsinatertiaryhospitalinningbochina |