title: Occurrence of Clostridium difficile infections due to PCR ribotype 027 in Bucharest, Romania.
abstract: BACKGROUND
  Little is known about prevailing ribotypes of Clostridium difficile infection in Romania where CDI is not a mandatory notifiable disease.
  
  
  METHODS
  We studied 64 non-duplicate C. difficile isolates from patients hospitalised at the National Institute of Infectious Diseases, Bucharest, Romania between March 2011 and March 2012.
  
  
  RESULTS
  Sixty-three of the 64 C. difficile isolates produced toxins A and B whereas 44 (69%) isolates produced a binary toxin. Ribotype 027 accounted for 43 (68%) of the 63 toxigenic strains. The remaining 20 isolates belonged to ribotypes 018 (n = 9), 012 (n = 3), and, with one isolate each, 014, 031, 081, 416, 433, 500, 507 and PR03035 (new ribotype). Information on hospital mortality was available for 62 of the 64 patients; among these 62 cases, 4 (6.4%) ended fatal. Recurrence was documented for 11 (18.3%) of the 60 patients for whom this information was available. Multilocus variable-number tandem repeat analysis of the 43 isolates of ribotype 027 yielded a unique cluster for the Romanian isolates when compared to Austrian or Italian isolates.
  
  
  CONCLUSIONS
  Our findings sustain the hypothesis of a recent emerged outbreak of C. difficile PCR ribotype 027 infections in the area of Bucharest.
authors.affiliation: National Institute for Infectious Diseases Matei Bals, Bucharest, Romania. arafila@yahoo.com.
authors.forename: Alexandru
authors.initials: A
authors.lastname: Rafila
authors.forename: Alexander
authors.initials: A
authors.lastname: Indra
authors.forename: Gabriel Adrian
authors.initials: GA
authors.lastname: Popescu
authors.forename: Günther
authors.initials: G
authors.lastname: Wewalka
authors.forename: Franz
authors.initials: F
authors.lastname: Allerberger
authors.forename: Serban
authors.initials: S
authors.lastname: Benea
authors.forename: Ioana
authors.initials: I
authors.lastname: Badicut
authors.forename: Richard
authors.initials: R
authors.lastname: Aschbacher
authors.forename: Steliana
authors.initials: S
authors.lastname: Huhulescu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001426:Bacterial Proteins / Q000096:biosynthesis; D001427:Bacterial Toxins / Q000096:biosynthesis; D016360:Clostridioides difficile / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology; D003906:Developing Countries; D004196:Disease Outbreaks; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology / Q000382:microbiology; D004768:Enterotoxins / Q000096:biosynthesis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D021521:Ribotyping; D012383:Romania / Q000453:epidemiology; D055815:Young Adult
chemical_list: D001426:Bacterial Proteins; D001427:Bacterial Toxins; D004768:Enterotoxins; C041348:tcdA protein, Clostridium difficile; C031815:toxB protein, Clostridium difficile