title: Molecular typing and epidemiology of Clostridium difficile in respiratory care wards of central Taiwan.
abstract: OBJECTIVE
  In industrialized countries, Clostridium difficile is the major cause of nosocomial diarrhea. This study involved a broad overview of baseline epidemiology for C. difficile in Taiwan.
  
  
  METHODS
  Point prevalence was estimated from a prospective survey conducted in the respiratory care wards of six hospitals in central Taiwan. Polymerase chain reaction (PCR) ribotyping and multiple-locus variable-number tandem-repeat analysis (MLVA) were performed on all toxigenic C. difficile isolates, including asymptomatic and symptomatic strains.
  
  
  RESULTS
  A total of 149 patients were screened for C. difficile; the point prevalence for C. difficile infection (CDI) and C. difficile colonization was 4% and 19%, respectively. CDI cases were significantly related to end-stage renal disease, and C. difficile colonization cases were significantly associated with previous admission to an acute-care facility. No hypervirulent PCR ribotype 027 strain was found. MLVA detected two clusters of CDI-related and three clusters of asymptomatic C. difficile strains circulating in wards.
  
  
  CONCLUSIONS
  Our results demonstrate a high prevalence of toxigenic C. difficile colonization in hospitals. Infection control personnel should pay attention to the increasing numbers of CDI cases, and molecular typing for C. difficile should be performed when necessary.
authors.affiliation: The Central Region Laboratory, Centers for Disease Control, Taichung, Taiwan.
authors.forename: Hsiao-Lun
authors.initials: HL
authors.lastname: Wei
authors.affiliation: The Third Branch Office, Centers for Disease Control, Taichung, Taiwan.
authors.forename: Sung-Hsi
authors.initials: SH
authors.lastname: Wei
authors.affiliation: Fongyuan Hospital, Taichung, Taiwan.
authors.forename: Chien-Wen
authors.initials: CW
authors.lastname: Huang
authors.affiliation: Nantou Hospital, Nantou County, Taiwan.
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Shih
authors.affiliation: Changhua Hospital, Changhua County, Taiwan.
authors.forename: Yi-Wen
authors.initials: YW
authors.lastname: Huang
authors.affiliation: Chung Shan Medical University Hospital, Taichung, Taiwan.
authors.forename: Min-Chi
authors.initials: MC
authors.lastname: Lu
authors.affiliation: Taichung Hospital, Taichung, Taiwan.
authors.forename: Jin-Chyr
authors.initials: JC
authors.lastname: Hsu
authors.affiliation: Puli Veterans Hospital, Nantou, Taiwan.
authors.forename: Yi-Sheng
authors.initials: YS
authors.lastname: Liou
authors.affiliation: The Central Region Laboratory, Centers for Disease Control, Taichung, Taiwan. Electronic address: nipmcsc@cdc.gov.tw.
authors.forename: Chien-Shun
authors.initials: CS
authors.lastname: Chiou
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016360:Clostridioides difficile / Q000145:classification* / Q000235:genetics* / Q000302:isolation & purification; D003015:Clostridium Infections / Q000139:chemically induced / Q000453:epidemiology* / Q000382:microbiology*; D016000:Cluster Analysis; D003428:Cross Infection / Q000139:chemically induced / Q000453:epidemiology / Q000382:microbiology; D003967:Diarrhea / Q000139:chemically induced / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D018598:Minisatellite Repeats; D017720:Molecular Epidemiology; D015995:Prevalence; D011446:Prospective Studies; D021521:Ribotyping; D013624:Taiwan / Q000453:epidemiology
keywords: Clostridium difficile; Molecular typing; Multiple-locus variable-number tandem-repeat analysis (MLVA); Prevalence