title: Predominance of PCR-ribotypes, 018 (smz) and 369 (trf) of Clostridium difficile in Japan: a potential relationship with other global circulating strains?
abstract: Global spread and evolutionary links of an epidemic Clostridium difficile strain (PCR-ribotype 027) have been noted in recent decades. However, in Japan, no outbreaks caused by type 027 have been reported to date. A total of 120 C. difficile isolates from patients at 15 hospitals during non-outbreak seasons between 2011 and 2013 as well as 18 and 21 isolates collected from two hospitals in 2010 and 2009, respectively, in outbreak periods in Japan, were examined. Among these 120 isolates, Japan-ribotypes smz and ysmz (subtype variant of smz) were the most predominant (39.2 %) followed by Japan-ribotype trf (15.8 %). Types smz/ysmz and trf were also concurrently predominant at two hospitals in the outbreak settings. Out of the five binary toxin-positive isolates observed, only one was PCR-ribotype 027 and another PCR-ribotype 078. Type smz was later found to correspond to PCR-ribotype 018. High rates of resistance against gatifloxacin, moxifloxacin, erythromycin and clindamycin were observed in the PCR-ribotype 018 isolates. Interestingly, all trf isolates were toxin A-negative, toxin B-positive, but they did not correspond to PCR-ribotype 017, thus being assigned a new ribotype (PCR-ribotype 369). In conclusion, PCR-ribotypes 018 (smz) and 369 (trf) were identified as major circulating strains in both outbreak and non-outbreak settings in Japan. Given their epidemiological relevance, molecular investigations are warranted to clarify potential evolutionary links with related strains found elsewhere, such as PCR-ribotypes 018 and 017 from Europe and North America.
authors.affiliation: Department of Bacteriology II, National Institute of Infectious Diseases, Tokyo, Japan.
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Senoh
authors.affiliation: Department of Bacteriology II, National Institute of Infectious Diseases, Tokyo, Japan.
authors.forename: Haru
authors.initials: H
authors.lastname: Kato
authors.affiliation: Department of Bacteriology II, National Institute of Infectious Diseases, Tokyo, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Fukuda
authors.affiliation: Ishikawa Prefectural Central Hospital, Ishikawa Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Niikawa
authors.affiliation: Okayama Saiseikai General Hospital, Okayama, Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Hori
authors.affiliation: Tsuyama Chuo Hospital, Okayama, Japan.
authors.forename: Hideharu
authors.initials: H
authors.lastname: Hagiya
authors.affiliation: Japanese Red Cross Gifu Hospital, Gifu, Japan.
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Ito
authors.affiliation: NHO Sendai Medical Center, Miyagi, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Miki
authors.affiliation: NHO Sendai Medical Center, Miyagi, Japan.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Abe
authors.affiliation: NHO Matsumoto Medical Center, Nagano, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Furuta
authors.affiliation: NHO Matsumoto Medical Center, Nagano, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Takeuchi
authors.affiliation: Aichi Cancer Center Hospital, Aichi, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Tajima
authors.affiliation: NHO Kure Medical Center, Hiroshima, Japan.
authors.forename: Harumi
authors.initials: H
authors.lastname: Tominaga
authors.affiliation: Chiba Cancer Center, Chiba, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Satomura
authors.affiliation: Toyokawa City Hospital, Aichi, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kato
authors.affiliation: Toyokawa City Hospital, Aichi, Japan.
authors.forename: Sayuri
authors.initials: S
authors.lastname: Morita
authors.affiliation: Toyokawa City Hospital, Aichi, Japan.
authors.forename: Ai
authors.initials: A
authors.lastname: Tanada
authors.affiliation: Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Toshinori
authors.initials: T
authors.lastname: Hara
authors.affiliation: Saitama City Hospital, Saitama, Japan.
authors.forename: Miki
authors.initials: M
authors.lastname: Kawada
authors.affiliation: Saitama City Hospital, Saitama, Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Sato
authors.affiliation: NHO Tokyo Medical Center, Tokyo, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Takahashi
authors.affiliation: NHO Tokyo Medical Center, Tokyo, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Higuchi
authors.affiliation: Tsuruoka Municipal Shonai Hospital, Yamagata, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Nakajima
authors.affiliation: Tsuruoka Municipal Shonai Hospital, Yamagata, Japan.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Wakamatsu
authors.affiliation: Osaka University Hospital, Osaka, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Toyokawa
authors.affiliation: Osaka University Hospital, Osaka, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Ueda
authors.affiliation: Liverpool Clinical Laboratories, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Roberts
authors.affiliation: Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK.
authors.forename: Fabio
authors.initials: F
authors.lastname: Miyajima
authors.affiliation: Department of Bacteriology II, National Institute of Infectious Diseases, Tokyo, Japan.
authors.forename: Keigo
authors.initials: K
authors.lastname: Shibayama
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016360:Clostridioides difficile / Q000145:classification* / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology*; D004269:DNA, Bacterial / Q000737:chemistry / Q000235:genetics; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D006761:Hospitals; D006801:Humans; D007564:Japan / Q000453:epidemiology; D017720:Molecular Epidemiology; D008969:Molecular Sequence Data; D015995:Prevalence; D021521:Ribotyping; D017422:Sequence Analysis, DNA
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial