title: Clinical features and characteristics of Clostridium difficile PCR-ribotype 176 infection: results from a 1-year university hospital internal ward study.
abstract: BACKGROUND
  Clostridium difficile infection (CDI) is a major cause of antibiotic-associated diarrhoea. Given an increasing CDI incidence and global spread of epidemic ribotypes, a 1-year study was performed to analyse the molecular characteristics of C. difficile isolates and associated clinical outcomes from patients diagnosed with CDI in the Internal Medicine department at University Hospital Motol, Prague from February 2013 to February 2014.
  
  
  RESULTS
  A total of 85 unformed stool samples were analysed and CDI was laboratory confirmed in 30 patients (6.8 CDI cases per 10,000 patient bed days and 50.6 CDI cases per 10,000 admissions). The CDI recurrence rate within 3 months of treatment discontinuation was 13.3% (4/30). Mortality within 3 months after first CDI episode was 26.7% (8/30), with CDI the cause of death in two cases. 51.9% of C. difficile isolates belonged to PCR-ribotype 176. MLVA of ribotype 176 isolates revealed two clonal complexes formed by 10/14 isolates. ATLAS scores and Horn's index were higher in patients with ribotype 176 infections than with non-ribotype 176 infections.
  
  
  CONCLUSIONS
  This study highlights the clinical relevance of C. difficile PCR-ribotype 176 and its capacity to spread within a healthcare facility.
authors.affiliation: Department of Internal Medicine, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, 150 06, V Uvalu 84, Praha 5, Prague, Czech Republic. jiri.drabek@lfmotol.cuni.cz.
authors.forename: Jiri
authors.initials: J
authors.lastname: Drabek
authors.affiliation: Department of Medical Microbiology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic. otakar.nyc@lfmotol.cuni.cz.
authors.forename: Otakar
authors.initials: O
authors.lastname: Nyc
authors.affiliation: Department of Medical Microbiology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic. marcela.krutova@seznam.cz.|DNA Laboratory, Department of Paediatric Neurology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic. marcela.krutova@seznam.cz.
authors.forename: Marcela
authors.initials: M
authors.lastname: Krutova
authors.affiliation: Department of Internal Medicine, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, 150 06, V Uvalu 84, Praha 5, Prague, Czech Republic. jan.stovicek@fnmotol.cz.
authors.forename: Jan
authors.initials: J
authors.lastname: Stovicek
authors.affiliation: Department of Medical Microbiology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic. jana.matejkova@lfmotol.cuni.cz.
authors.forename: Jana
authors.initials: J
authors.lastname: Matejkova
authors.affiliation: Department of Internal Medicine, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, 150 06, V Uvalu 84, Praha 5, Prague, Czech Republic. Radan.Keil@fnmotol.cz.
authors.forename: Radan
authors.initials: R
authors.lastname: Keil
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects*; D016360:Clostridioides difficile / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality / Q000473:pathology*; D018153:Czech Republic / Q000453:epidemiology; D003967:Diarrhea / Q000139:chemically induced* / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology*; D005243:Feces / Q000382:microbiology; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D016133:Polymerase Chain Reaction; D012008:Recurrence; D021521:Ribotyping; D016019:Survival Analysis
chemical_list: D000900:Anti-Bacterial Agents