title: Clostridium difficile isolates with increased sporulation: emergence of PCR ribotype 002 in Hong Kong.
abstract: We identified a predominant clone of Clostridium difficile PCR ribotype 002, which was associated with an increased sporulation frequency. In 2009, 3,528 stool samples from 2,440 patients were tested for toxigenic C. difficile in a healthcare region in Hong Kong. A total of 345 toxigenic strains from 307 (13.3%) patients were found. Ribotype 002 was the predominant ribotype, which constituted 35 samples from 29 (9.4%) patients. The mean sporulation frequency of ribotype 002 was 20.2%, which was significantly higher than that of the 56 randomly selected ribotypes other than 002 as concurrent controls (3.7%, p < 0.001). Patients carrying toxigenic ribotype 002 were more frequently admitted from an elderly home (p = 0.01) and received more β-lactam antibiotics in the preceding 3 months compared with the controls (p = 0.04) . The identification of toxigenic ribotype 002 in 2009 was temporally related to a significant increase in both the incidence of toxigenic C. difficile from 0.53 to 0.95 per 1,000 admissions (p < 0.001) and the rate of positive detection from 4.17% to 6.28% (p < 0.001) between period 1 (2004-2008) and period 2 (2009). This finding should alert both the physician and the infection control team to the establishment of and possible outbreaks by ribotype 002 in our hospitals, as in the case of ribotype 027.
authors.affiliation: Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China.
authors.forename: V C C
authors.initials: VC
authors.lastname: Cheng
authors.forename: W C
authors.initials: WC
authors.lastname: Yam
authors.forename: O T C
authors.initials: OT
authors.lastname: Lam
authors.forename: J L Y
authors.initials: JL
authors.lastname: Tsang
authors.forename: E Y F
authors.initials: EY
authors.lastname: Tse
authors.forename: G K H
authors.initials: GK
authors.lastname: Siu
authors.forename: J F W
authors.initials: JF
authors.lastname: Chan
authors.forename: H
authors.initials: H
authors.lastname: Tse
authors.forename: K K W
authors.initials: KK
authors.lastname: To
authors.forename: J W M
authors.initials: JW
authors.lastname: Tai
authors.forename: P L
authors.initials: PL
authors.lastname: Ho
authors.forename: K Y
authors.initials: KY
authors.lastname: Yuen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001426:Bacterial Proteins / Q000235:genetics* / Q000378:metabolism; D001427:Bacterial Toxins / Q000378:metabolism; D016360:Clostridioides difficile / Q000145:classification* / Q000187:drug effects / Q000302:isolation & purification / Q000502:physiology*; D016000:Cluster Analysis; D004761:Enterocolitis, Pseudomembranous / Q000382:microbiology*; D004768:Enterotoxins / Q000378:metabolism; D005243:Feces / Q000382:microbiology; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D021521:Ribotyping; D013171:Spores, Bacterial; D055815:Young Adult
chemical_list: D001426:Bacterial Proteins; D001427:Bacterial Toxins; D004768:Enterotoxins; C070683:surface layer protein A, Bacteria; C041348:tcdA protein, Clostridium difficile; C031815:toxB protein, Clostridium difficile