title: Molecular epidemiology and antimicrobial susceptibility of Clostridium difficile isolates from two Korean hospitals.
abstract: Clostridium difficile is one of the main etiological agents causing antibiotic-associated diarrhea. This study investigated the genetic diversity of 70 toxigenic C. difficile isolates from two Korean hospitals by employing toxinotyping, ribotyping, multilocus sequence typing (MLST), and pulsed-field gel electrophoresis (PFGE). Toxin gene amplification resulted in 68 A⁺B⁺ and two A-B+ isolates. Most isolates (95.7-100%) were susceptible to daptomycin, metronidazole, and vancomycin. Seventy C. difficile isolates were classified into five toxinotypes, 19 ribotypes, 16 sequence types (STs), and 33 arbitrary pulsotypes. All C. difficile isolates of ribotype 018 (n = 38) were classified into ST17, which was the most prevalent ST in both hospitals. However, C. difficile isolates of ST17 (ribotype 018) exhibited pulsotypes that differed by hospital. ST2 (ribotype 014/020), 8 (ribotypes 002), 17 (ribotype 018), and 35 (ribotypes 015) were detected in both hospitals, whereas other STs were unique to each hospital. Statistical comparison of the different typing methods revealed that ribotyping and PFGE were highly predictive of STs. In conclusion, our epidemiological study indicates that C. difficile infections in both hospitals are associated with the persistence of endemic clones coupled with the emergence of many unique clones. A combination of MLST with PFGE or ribotyping could be useful for monitoring epidemic C. difficile strains and the emergence of new clones in hospitals.
authors.affiliation: Department of Microbiology, Kyungpook National University School of Medicine, Daegu, Republic of Korea.
authors.forename: Asiimwe
authors.initials: A
authors.lastname: Nicholas
authors.affiliation: Department of Laboratory Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea.
authors.forename: Yu Kyung
authors.initials: YK
authors.lastname: Kim
authors.affiliation: Department of Laboratory Medicine, Kyungpook National University School of Medicine, Daegu, Republic of Korea.
authors.forename: Won-Kil
authors.initials: WK
authors.lastname: Lee
authors.affiliation: Department of Microbiology, Kyungpook National University School of Medicine, Daegu, Republic of Korea.
authors.forename: Gati Noble
authors.initials: GN
authors.lastname: Selasi
authors.affiliation: Department of Microbiology, Kyungpook National University School of Medicine, Daegu, Republic of Korea.
authors.forename: Seok Hyeon
authors.initials: SH
authors.lastname: Na
authors.affiliation: Department of Microbiology, Kyungpook National University School of Medicine, Daegu, Republic of Korea.
authors.forename: Hyo Il
authors.initials: HI
authors.lastname: Kwon
authors.affiliation: Department of Microbiology, Kyungpook National University School of Medicine, Daegu, Republic of Korea.
authors.forename: Yoo Jeong
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Laboratory Medicine, Kyungpook National University School of Medicine, Daegu, Republic of Korea.
authors.forename: Hae Sook
authors.initials: HS
authors.lastname: Lee
authors.affiliation: Department of Laboratory Medicine, Kyungpook National University School of Medicine, Daegu, Republic of Korea.
authors.forename: Kyung Eun
authors.initials: KE
authors.lastname: Song
authors.affiliation: Department of Laboratory Medicine, Inje University College of Medicine, Busan, Republic of Korea.
authors.forename: Jeong Hwan
authors.initials: JH
authors.lastname: Shin
authors.affiliation: Department of Microbiology, Kyungpook National University School of Medicine, Daegu, Republic of Korea.
authors.forename: Je Chul
authors.initials: JC
authors.lastname: Lee
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D044466:Asian People; D016360:Clostridioides difficile / Q000145:classification / Q000187:drug effects* / Q000235:genetics*; D003015:Clostridium Infections / Q000453:epidemiology / Q000208:ethnology / Q000382:microbiology*; D003428:Cross Infection / Q000453:epidemiology / Q000208:ethnology / Q000382:microbiology*; D017576:Daptomycin / Q000494:pharmacology; D003967:Diarrhea / Q000453:epidemiology / Q000208:ethnology / Q000382:microbiology; D016521:Electrophoresis, Gel, Pulsed-Field / Q000379:methods; D005243:Feces / Q000382:microbiology; D005798:Genes, Bacterial / Q000235:genetics; D006761:Hospitals; D006801:Humans; D008795:Metronidazole / Q000494:pharmacology; D008826:Microbial Sensitivity Tests / Q000379:methods*; D017720:Molecular Epidemiology / Q000379:methods; D058885:Multilocus Sequence Typing; D015203:Reproducibility of Results; D056910:Republic of Korea / Q000453:epidemiology; D021521:Ribotyping; D014640:Vancomycin / Q000494:pharmacology
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D014640:Vancomycin; D017576:Daptomycin