Investigation of toxin gene diversity, molecular epidemiology, and antimicrobial resistance of Clostridium difficile isolated from 12 hospitals in South Korea

Heejung Kim, Seok Hoon Jeong, Kyoung Ho Roh, Seong Geun Hong, Jong Wan Kim, Myung Geun Shin, Mi Na Kim, Hee Bong Shin, Young Uh, Hyukmin Lee, Kyungwon Lee

Research output: Contribution to journalArticle

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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 AB+ 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 AB+ strains showed this pattern. We did not isolate strains with decreased susceptibility to metronidazole or vancomycin.

Original languageEnglish
Pages (from-to)491-497
Number of pages7
JournalKorean Journal of Laboratory Medicine
Volume30
Issue number5
DOIs
Publication statusPublished - 2010 Oct 1

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Ribotyping
Clostridium
Republic of Korea
Molecular Epidemiology
Clostridium difficile
Genes
Korea
Metronidazole
Vancomycin
Polymerase Chain Reaction
Cefotetan
Cefoxitin
Diarrhea
Piperacillin
Clindamycin
Imipenem
Ampicillin
Dilution
Agar
Teaching

All Science Journal Classification (ASJC) codes

  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

Kim, Heejung ; Jeong, Seok Hoon ; Roh, Kyoung Ho ; Hong, Seong Geun ; Kim, Jong Wan ; Shin, Myung Geun ; Kim, Mi Na ; Shin, Hee Bong ; Uh, Young ; Lee, Hyukmin ; Lee, Kyungwon. / Investigation of toxin gene diversity, molecular epidemiology, and antimicrobial resistance of Clostridium difficile isolated from 12 hospitals in South Korea. In: Korean Journal of Laboratory Medicine. 2010 ; Vol. 30, No. 5. pp. 491-497.
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title = "Investigation of toxin gene diversity, molecular epidemiology, and antimicrobial resistance of Clostridium difficile isolated from 12 hospitals in South Korea",
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 AB+ 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 AB+ strains showed this pattern. We did not isolate strains with decreased susceptibility to metronidazole or vancomycin.",
author = "Heejung Kim and Jeong, {Seok Hoon} and Roh, {Kyoung Ho} and Hong, {Seong Geun} and Kim, {Jong Wan} and Shin, {Myung Geun} and Kim, {Mi Na} and Shin, {Hee Bong} and Young Uh and Hyukmin Lee and Kyungwon Lee",
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Investigation of toxin gene diversity, molecular epidemiology, and antimicrobial resistance of Clostridium difficile isolated from 12 hospitals in South Korea. / Kim, Heejung; Jeong, Seok Hoon; Roh, Kyoung Ho; Hong, Seong Geun; Kim, Jong Wan; Shin, Myung Geun; Kim, Mi Na; Shin, Hee Bong; Uh, Young; Lee, Hyukmin; Lee, Kyungwon.

In: Korean Journal of Laboratory Medicine, Vol. 30, No. 5, 01.10.2010, p. 491-497.

Research output: Contribution to journalArticle

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 - 2010/10/1

Y1 - 2010/10/1

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 AB+ 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 AB+ strains showed this pattern. We did not isolate strains with decreased susceptibility to metronidazole or vancomycin.

AB - 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 AB+ 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 AB+ strains showed this pattern. We did not isolate strains with decreased susceptibility to metronidazole or vancomycin.

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