title: Detection of cross-infection associated to a Brazilian PCR-ribotype of Clostridium difficile in a university hospital in Rio de Janeiro, Brazil.
abstract: Clostridium difficile is an important nosocomial enteric pathogen and is the etiological agent of pseudomembranous colites. Recently, the rates of C. difficile infection (CDI) have increased worldwide, but in Brazil few data about this situation and the incidence of clonal types of C. difficile exist. This study aimed to isolate and characterize C. difficile strains from samples obtained of a university hospital (HUCFF) in Rio de Janeiro city, Brazil. CDI was identified by ELISA in 27.1% of HUCFF-in-patients enrolled in the study, and the bacterium was recovered from eight of these fecal samples. All strains, except one, presented tcdA and tcdB genes and presented neither the cdtA and cdtB genes nor any significant deletions in the tcdC gene. All strains were sensitive to metronidazole, vancomycin and moxifloxacin, and resistant to clindamycin, ciprofloxacin and levofloxacin. PCR-ribotyping and PFGE revealed four different clonal types among the isolates. The Brazilian PCR-ribotype 133 accounted for 50% of strains isolated, and PCR-ribotype 233 strains were obtained from 25% of the in-patients. The prevalence and resurgence of the Brazilian PCR-ribotype 133 among the hospitalized patients of HUCFF was established, and cross-infection of different patients associated to the same PCR-ribotypes was detected. Our results emphasize the importance of the diagnosis and control of CDI in order to prevent the emergence of specific clones that can lead to C. difficile-associated outbreaks in Brazilian hospitals.
authors.affiliation: Laboratório de Biologia de Anaeróbios-Instituto de Microbiologia Prof. Paulo de Góes-Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro-Cidade Universitária, Rio de Janeiro, Brazil. ilana@ioc.fiocruz.br
authors.forename: Ilana T
authors.initials: IT
authors.lastname: Balassiano
authors.forename: Joaquim
authors.initials: J
authors.lastname: dos Santos-Filho
authors.forename: Juliana M
authors.initials: JM
authors.lastname: Vital-Brazil
authors.forename: Simone A
authors.initials: SA
authors.lastname: Nouér
authors.forename: Claudia R C
authors.initials: CR
authors.lastname: Souza
authors.forename: Jon S
authors.initials: JS
authors.lastname: Brazier
authors.forename: Eliane de O
authors.initials: Ede O
authors.lastname: Ferreira
authors.forename: Regina M C P
authors.initials: RM
authors.lastname: Domingues
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001426:Bacterial Proteins / Q000235:genetics; D001427:Bacterial Toxins / Q000235:genetics; D015373:Bacterial Typing Techniques; D001938:Brazil / Q000453:epidemiology; D016360:Clostridioides difficile / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology; D016000:Cluster Analysis; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D016172:DNA Fingerprinting; D024881:Drug Resistance, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D004768:Enterotoxins / Q000235:genetics; D005260:Female; D005838:Genotype; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D021521:Ribotyping / Q000379:methods
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001427:Bacterial Toxins; D004768:Enterotoxins; C041348:tcdA protein, Clostridium difficile; C031815:toxB protein, Clostridium difficile