title: Molecular Epidemiology of Clostridium difficile Infection in Hospitalized Patients in Eastern China.
abstract: Few studies on risk factors for and transmission ofClostridium difficileinfection (CDI) in China have been reported. A cross-sectional study was conducted for 3 years in eastern China. Consecutive stool specimens from hospitalized patients with diarrhea were cultured forC. difficile. C. difficileisolates from these patients then were analyzed for toxin genes, genotypes, and antimicrobial resistance. A severity score for the CDI in each patient was determined by a blinded review of the medical record, and these scores ranged from 1 to 6. A total of 397 out of 3,953 patients (10.0%) with diarrhea were found to have CDI. Severity of CDI was mild to moderate, and the average (± standard deviation) severity score was 2.61 ± 1.01.C. difficilewas isolated from stool specimens in 432 (10.9%) of all the patients who had diarrhea.C. difficilegenotypes were determined by multilocus sequence analysis and PCR ribotyping; sequence type 37 (ST37)/ribotype 017 (RT017) (n= 68, 16.5%) was the dominant genotype. Eleven patients (16.2%) with this genotype had a CDI severity score of 5. Overall, three RTs and four STs were predominant; these genotypes were associated with significantly different antimicrobial resistance patterns in comparison to all genotypes (χ2= 79.56 to 97.76;P< 0.001). Independent risk factors associated with CDI included age greater than 55 years (odds ratio [95% confidence interval], 26.80 [18.76 to 38.29]), previous hospitalization (12.42 [8.85 to 17.43]), previous antimicrobial treatment within 8 weeks (150.56 [73.11 to 310.06]), hospital stay more than 3 days before sampling (2.34 [1.71 to 3.22]), undergoing chemotherapy (3.31 [2.22 to 4.92]), and undergoing abdominal surgery (4.82 [3.54 to 6.55]). CDI is clearly a problem in eastern China and has a prevalence of 10.0% in hospitalized patients. Among risk factors for CDI, the advanced age threshold was younger for Chinese patients than that reported for patients in developed countries.
authors.affiliation: Department of Microbiology, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China dzjin@cdc.zj.cn tangy@mskcc.org.|Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
authors.forename: Dazhi
authors.identifier: 0000-0001-7738-1778
authors.initials: D
authors.lastname: Jin
authors.affiliation: Department of Microbiology, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Luo
authors.affiliation: Department of Microbiology, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Huang
authors.affiliation: Department of Disease Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Cai
authors.affiliation: Department of Microbiology, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors.forename: Julian
authors.initials: J
authors.lastname: Ye
authors.affiliation: Biotherapy Center for Medical Oncology, the First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Zheng
authors.affiliation: Department of Laboratory Medicine, Hangzhou First People's Hospital, Hangzhou, Zhejiang, China.
authors.forename: Liqian
authors.initials: L
authors.lastname: Wang
authors.affiliation: Biotherapy Center for Medical Oncology, the First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Zhao
authors.affiliation: Department of Laboratory Medicine, Hangzhou First People's Hospital, Hangzhou, Zhejiang, China.
authors.forename: Anbing
authors.initials: A
authors.lastname: Liu
authors.affiliation: Biotherapy Center for Medical Oncology, the First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China.
authors.forename: Weijia
authors.initials: W
authors.lastname: Fang
authors.affiliation: Department of Laboratory Medicine, Hangzhou First People's Hospital, Hangzhou, Zhejiang, China.
authors.forename: Xianjun
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Microbiology, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.|Department of Disease Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors.forename: Shichang
authors.initials: S
authors.lastname: Xia
authors.affiliation: Department of Microbiology, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.|Department of Disease Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
authors.forename: Jianmin
authors.initials: J
authors.lastname: Jiang
authors.affiliation: Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA dzjin@cdc.zj.cn tangy@mskcc.org.|Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, New York, New York, USA.
authors.forename: Yi-Wei
authors.identifier: 0000-0003-4888-6771
authors.initials: YW
authors.lastname: Tang
mesh_terms: D000368:Aged; D001427:Bacterial Toxins / Q000235:genetics; D002681:China; D016360:Clostridioides difficile / Q000145:classification* / Q000235:genetics* / Q000302:isolation & purification; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D003428:Cross Infection / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D024881:Drug Resistance, Bacterial; D005260:Female; D005838:Genotype; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D058885:Multilocus Sequence Typing; D021521:Ribotyping; D012307:Risk Factors
chemical_list: D001427:Bacterial Toxins
keywords: Clostridium difficile infection; clinical features; cross-sectional study; molecular characterization; risk factor