title: Predominance of Clostridium difficile Ribotypes 017 and 078 among Toxigenic Clinical Isolates in Southern Taiwan.
abstract: Ribotypes and toxin genotypes of clinical C. difficile isolates in Taiwan are rarely reported. A prospective surveillance study from January 2011 to January 2013 was conducted at the medical wards of a district hospital in southern Taiwan. Of the first toxigenic isolates from 120 patients, 68 (56.7%) of 120 isolates possessed both tcdA and tcdB. Of 52 (43.3%) with tcdB and truncated tcdA (tcdA-/tcdB+), all were ribotype 017 and none had binary toxin or tcdC deletion. Eighteen (15%) toxigenic isolates harbored binary toxins (cdtA and cdtB) and all had tcdC deletion, including Δ39 (C184T) deletion (14 isolates), Δ18 in-frame deletion (3 isolates), and Δ18 (Δ117A) deletion (1 isolate). Eleven of 14 isolates with Δ39 (C184T) deletion belonged to the ribotype 078 family, including ribotype 127 (6 isolates), ribotype 126 (4 isolates), and ribotype 078 (1 isolate). Among 8 patients with consecutive C. difficile isolates, these isolates from 6 (75%) patients were identical, irrespective of the presence or absence of diarrhea, suggestive of persistent fecal carriage or colonization. In conclusion in southern Taiwan, ribotype 017 isolates with a tcdA-/tcdB+ genotype were not uncommon and of C. difficile isolates with binary toxin, the ribotype 078 family was predominant.
authors.affiliation: Department of Internal Medicine, Tainan Hospital, Ministry of Health & Welfare, Tainan, Taiwan.|Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.|Graduate Institute of Clinical Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: Yuan-Pin
authors.initials: YP
authors.lastname: Hung
authors.affiliation: Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.|Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan, Taiwan.
authors.forename: I-Hsiu
authors.initials: IH
authors.lastname: Huang
authors.affiliation: Department of Internal Medicine, Tainan Hospital, Ministry of Health & Welfare, Tainan, Taiwan.|Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.|Graduate Institute of Clinical Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: Hsiao-Ju
authors.initials: HJ
authors.lastname: Lin
authors.affiliation: Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Bo-Yang
authors.initials: BY
authors.lastname: Tsai
authors.affiliation: Department of Internal Medicine, Tainan Hospital, Ministry of Health & Welfare, Tainan, Taiwan.|Department of Experiment and Diagnosis, Tainan Hospital, Ministry of Health & Welfare, Tainan, Taiwan.
authors.forename: Hsiao-Chieh
authors.initials: HC
authors.lastname: Liu
authors.affiliation: Department of Experiment and Diagnosis, Tainan Hospital, Ministry of Health & Welfare, Tainan, Taiwan.
authors.forename: Hsiu-Chuan
authors.initials: HC
authors.lastname: Liu
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: Jen-Chieh
authors.initials: JC
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, E-da Hospital, Kaohsiung, Taiwan.
authors.forename: Yi-Hui
authors.initials: YH
authors.lastname: Wu
authors.affiliation: Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.|Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.|Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Pei-Jane
authors.initials: PJ
authors.lastname: Tsai
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.|Center of Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan.|Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Wen-Chien
authors.initials: WC
authors.lastname: Ko
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001427:Bacterial Toxins / Q000235:genetics; D016360:Clostridioides difficile / Q000145:classification* / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000382:microbiology*; D004768:Enterotoxins / Q000235:genetics; D005838:Genotype; D006801:Humans; D008826:Microbial Sensitivity Tests; D012091:Repetitive Sequences, Nucleic Acid; D021521:Ribotyping; D017384:Sequence Deletion; D013624:Taiwan / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D001427:Bacterial Toxins; D004768:Enterotoxins