title: Isolation of the first three cases of Clostridium difficile polymerase chain reaction ribotype 027 in Singapore.
abstract: BACKGROUND
  The incidence of Clostridium (C.) difficile infection (CDI) was on the rise from 2001 to 2006 in Singapore. Recent unpublished data suggests that its incidence had remained stable or decreased in most local public hospitals between 2006 and 2010. It is, however, not known if the polymerase chain reaction (PCR) ribotype 027 strains have been circulating, although reports suggest that this strain is emerging in Asia, with the first cases reported from Japan in 2007, as well as in Hong Kong and Australia in 2009. We initiated a culture-based surveillance to detect this epidemic strain in Singapore.
  
  
  METHODS
  From September 2008 to December 2009, all non-duplicate toxin-positive stool samples from the three largest public hospitals in Singapore were collected for culture and further analysis.
  
  
  RESULTS
  Out of the 366 samples collected, 272 viable isolates were cultured. Of these, 240 tested toxin-positive and ten tested positive for the binary toxin gene; 35 different PCR ribotypes were found. Three isolates that tested positive for binary toxin contained the same PCR ribotyping pattern as the C. difficile 027 control strain. All three had the 18-bp deletion and single nucleotide tcdC deletion at position 117. Susceptibility testing was performed, demonstrating susceptibility to erythromycin and moxifloxacin.
  
  
  CONCLUSIONS
  We report the first three isolates of C. difficile 027 from Singapore. However, their susceptibility patterns are more consistent with the historical 027 strains. Rising CDI incidence may not be associated with the emergence of the epidemic 027 strain at this time.
authors.affiliation: Communicable Disease Division, Ministry of Health, 16 College Road, Singapore 169854. pllim@post.harvard.edu
authors.forename: P L
authors.initials: PL
authors.lastname: Lim
authors.forename: M L
authors.initials: ML
authors.lastname: Ling
authors.forename: H Y
authors.initials: HY
authors.lastname: Lee
authors.forename: T H
authors.initials: TH
authors.lastname: Koh
authors.forename: A L
authors.initials: AL
authors.lastname: Tan
authors.forename: E J
authors.initials: EJ
authors.lastname: Kuijper
authors.forename: S S
authors.initials: SS
authors.lastname: Goh
authors.forename: B S
authors.initials: BS
authors.lastname: Low
authors.forename: L P
authors.initials: LP
authors.lastname: Ang
authors.forename: C
authors.initials: C
authors.lastname: Harmanus
authors.forename: R T
authors.initials: RT
authors.lastname: Lin
authors.forename: P
authors.initials: P
authors.lastname: Krishnan
authors.forename: L
authors.initials: L
authors.lastname: James
authors.forename: C E
authors.initials: CE
authors.lastname: Lee
mesh_terms: D015373:Bacterial Typing Techniques; D016360:Clostridioides difficile / Q000235:genetics*; D003015:Clostridium Infections / Q000453:epidemiology / Q000235:genetics*; D003428:Cross Infection; D024881:Drug Resistance, Bacterial / Q000235:genetics; D058872:Epidemics; D006779:Hospitals, Public; D006801:Humans; D008826:Microbial Sensitivity Tests; D016133:Polymerase Chain Reaction / Q000379:methods*; D011446:Prospective Studies; D021521:Ribotyping; D012846:Singapore