title: Toxin A-negative toxin B-positive ribotype 017 Clostridium difficile is the dominant strain type in patients with diarrhoea attending tuberculosis hospitals in Cape Town, South Africa.
abstract: The molecular epidemiology of C. difficile strains causing disease in South Africa is currently unknown. Previously, multidrug resistant ribotype (RT)017 strains were those most commonly isolated from patients with diarrhoea attending Groote Schuur Hospital in Cape Town, South Africa. This larger study aimed to investigate the molecular epidemiology and antibiotic susceptibility profiles of C. difficile strains in the greater Cape Town and regional areas. C. difficile strains were isolated from patients with diarrhoea attending hospitals in the Western Cape region of South Africa that tested positive using the GeneXpert CDiff diagnostic test. Ribotyping and multilocus variable-number tandem-repeat analysis (MLVA) were used to type isolates, and their susceptibilities to several antibiotics were determined by gradient diffusion test strips. A total of 269 non-repeat C. difficile isolates were obtained. A large proportion of isolates (64.3 %) belonged to the RT017 group, many of which were clonally related when investigated by MLVA. RT017 strains were particularly prevalent in patients attending specialist tuberculosis (TB) hospitals. The majority of RT017 isolates were co-resistant to moxifloxacin and rifampicin, two antibiotics which are used intensively during anti-TB therapy. Non-RT017 strains were generally susceptible to both antibiotics. Resistance to erythromycin was observed for both groups of strains. RT017 C. difficile strains are the most commonly isolated strains from patients attending healthcare facilities in the greater Cape Town and regional areas. The presence of multidrug resistant RT017 strains in patients with diarrhoea attending local TB hospitals reflects a potential reservoir for future infections.
authors.affiliation: Department of Molecular and Cell Biology, University of Cape Town, Cape Town, South Africa.
authors.forename: B
authors.initials: B
authors.lastname: Kullin
authors.affiliation: National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa.|Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa.
authors.forename: J
authors.initials: J
authors.lastname: Wojno
authors.affiliation: Department of Molecular and Cell Biology, University of Cape Town, Cape Town, South Africa.
authors.forename: V
authors.initials: V
authors.lastname: Abratt
authors.affiliation: Department of Molecular and Cell Biology, University of Cape Town, Cape Town, South Africa. shez.reid@uct.ac.za.
authors.forename: S J
authors.initials: SJ
authors.lastname: Reid
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001426:Bacterial Proteins / Q000378:metabolism*; D001427:Bacterial Toxins / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology; D052978:Disk Diffusion Antimicrobial Tests; D004768:Enterotoxins / Q000172:deficiency*; D004917:Erythromycin / Q000494:pharmacology; D005260:Female; D024841:Fluoroquinolones / Q000494:pharmacology; D006763:Hospitals, Chronic Disease; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D018598:Minisatellite Repeats; D017720:Molecular Epidemiology; D000077266:Moxifloxacin; D021521:Ribotyping; D012293:Rifampin / Q000494:pharmacology; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001427:Bacterial Toxins; D004768:Enterotoxins; D024841:Fluoroquinolones; C041348:tcdA protein, Clostridium difficile; C031815:toxB protein, Clostridium difficile; D004917:Erythromycin; D000077266:Moxifloxacin; D012293:Rifampin