ArticleBMC infectious diseases2019
Epidemiology of Clostridium difficile infection in hospitalized adults and the first isolation of C. difficile PCR ribotype 027 in central China.
Article in BMC infectious diseases, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 2 of them syntheses that pooled it.
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Who cites it
15 citing papers in PubMed, 2 syntheses or guidelines pooled it, 30 citations in OpenAlex.
- Pooled it
- Antimicrobial resistance in Clostridioides (Clostridium) difficile derived from humans: a systematic review and meta-analysis.Antimicrobial resistance and infection control · 2020Pooled it
- Clinical outcomes of toxin-positive versus toxin-negative/NAAT-positive Clostridioides difficile infection in South Korea: a single-center retrospective cohort study.BMC infectious diseases · 2026Article
- A severe Clostridioides difficile ribotype 027 infection in Beijing, China, july 2024.BMC infectious diseases · 2025Article
- Progress and gaps in antimicrobial resistance research within One Health sectors in China: a systematic analysis.Science China. Life sciences · 2025Article
- Mechanisms ofFrontiers in cellular and infection microbiology · 2025Review
- Article
- Gut microbiome changes in mouse, Mongolian gerbil, and hamster models followingFrontiers in microbiology · 2024Article
- Examining the Extent of Contamination, Antibiotic Resistance, and Genetic Diversity ofBioMed research international · 2023Article
- Genomic Epidemiology and Antimicrobial Resistance Profiles ofInfection and drug resistance · 2023Article
- Loop mediated isothermal amplification of Clostridioides difficile isolates in gastrointestinal patients.AMB Express · 2022Article
- Whole-Genome Sequencing Reveals the High Nosocomial Transmission and Antimicrobial Resistance of Clostridioides difficile in a Single Center in China, a Four-Year Retrospective Study.Microbiology spectrum · 2022Article
- Chromosomal Resistance to Metronidazole in Clostridioides difficile Can Be Mediated by Epistasis between Iron Homeostasis and Oxidoreductases.Antimicrobial agents and chemotherapy · 2020Article
- High Prevalence of Multidrug-ResistantFrontiers in cellular and infection microbiology · 2020Article
- Rescue fecal microbiota transplantation for antibiotic-associated diarrhea in critically ill patients.Critical care (London, England) · 2019Article
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Authors and funding
7 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundClostridium difficile infection (CDI) is an emerging healthcare problem in the world. The purpose of this study was to perform a systematic epidemiological research of CDI in Tongji hospital, the central of China.
methodsStool samples from hospitalized adults suspected of CDI were enrolled. The diagnosis of CDI were based on the combination of clinical symptoms and laboratory results. Clinical features of CDI and non-CDI patients were compared by appropriate statistical tests to determine the risk factors of CDI. Multilocus sequence typing (MLST) was employed for molecular epidemiological analysis. Susceptibility testing and relevant antimicrobial agent resistance genes were performed as well.
resultsFrom June 2016 to September 2017, 839 hospitalized adults were enrolled. Among them, 107 (12.8%, 107/839) patients were C. difficile culture positive, and 73 (8.7%, 73/839) were infected with toxigenic C. difficile (TCD), with tcdA + tcdB+ strains accounting for 90.4% (66/73) and tcdA-tcdB+ for 9.6% (7/73). Meanwhile, two TCD strains were binary toxin positive and one of them was finally identified as CD027. Severe symptoms were observed in these two cases. Multivariate analysis indicated antibiotic exposure (p = 0.001, OR = 5.035) and kidney disease (p = 0.015, OR = 8.329) significantly increased the risk of CDI. Phylogenetic tree analysis demonstrated 21 different STs, including one new ST (ST467); and the most dominant type was ST54 (35.6%, 26/73). Multidrug-resistant (MDR) TCD were 53.4% (39/73); resistance to ciprofloxacin, erythromycin, and clindamycin were > 50%. Other antibiotics showed relative efficiency and all strains were susceptible to metronidazole and vancomycin. All moxifloxacin-resistant isolates carried a mutation in GyrA (Thr82 → Ile), with one both having mutation in GyrB (Ser366 → Ala).
conclusionsKnowledge of epidemiological information for CDI is limited in China. Our finding indicated tcdA + tcdB+ C. difficile strains were the dominant for CDI in our hospital. Significant risk factors for CDI in our setting appeared to be antibiotic exposure and kidney disease. Metronidazole and vancomycin were still effective for CDI. Although no outbreak was observed, the first isolation of CD027 in center China implied the potential spread of this hypervirulent clone. Further studies are needed to enhance our understanding of the epidemiology of CDI in China.
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