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Molecular epidemiology and antimicrobial susceptibility of Clostridium difficile isolates from two Korean hospitals.

Molecular epidemiology and antimicrobial susceptibility of Clostridium difficile isolates from two Korean hospitals.
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Nicholas A, Kim YK, Lee WK, Selasi GN, Na SH, Kwon HI, Kim YJ, Lee HS, Song KE, Shin JH, Lee JC,


Nicholas A, Kim YK, Lee WK, Selasi GN, Na SH, Kwon HI, Kim YJ, Lee HS, Song KE, Shin JH, Lee JC, (click to view)

Nicholas A, Kim YK, Lee WK, Selasi GN, Na SH, Kwon HI, Kim YJ, Lee HS, Song KE, Shin JH, Lee JC,

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PloS one 2017 03 2912(3) e0174716 doi 10.1371/journal.pone.0174716
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.

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