Open AccessFirst Report of Clostridium difficile NAP1/027 in a Mexican Hospital
Author(s) -
Adrián Camacho-Ortíz,
Daniel López-Barrera,
Raúl Hernández-García,
Alejandra M. Galván-De los Santos,
Samantha Flores-Treviño,
Jorge Llaca-Díaz,
Héctor J. Maldonado Garza,
Francisco Bosques-Padilla,
Elvira GarzaGonzález
Publication year - 2015
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0122627
Subject(s) - clostridium difficile , c difficile , clostridium infections , medicine , microbiology and biotechnology , intensive care medicine , biology , antibiotics
Background and Objective Clostridium difficile NAP1/ribotype 027 is associated with severe disease and high mortality rates. Our aim was to determine the prevalence of NAP1/ribotype 027 among C . difficile isolates in a tertiary care hospital, and review the main clinical data. Methods We included 106 stool samples from 106 patients. Samples were tested for A&B toxins and were cultured on CCFA agar. The genes tcdA , tcdB , tcdC , cdtA , and cdtB were amplified using PCR in clinical isolates. The tcdA 3’-end deletion analysis, PCR-ribotyping, and pulsed-field gel electrophoresis (PFGE) were also performed. Stool samples that were positive for culture were tested by the GeneXpert C . difficile assay. Clinical data were collected. Results Thirty-six patients tested positive for A&B toxins; and 22 patients had positive culture for C . difficile , 14 of which tested positive for the A&B toxins and all 22 patients tested positive by the GeneXpert C . difficile assay. Risk factors included an average hospital stay of 16.1 days prior to toxin detection, average antibiotic use for 16.2 days, and a median of 3 antibiotics used. The 30-day crude mortality rate was 8.4%. Six of the 22 patients died, and 3 of those deaths were directly attributed to C . difficile infection. The majority of isolates, 90.9% (20/22), carried genes tcdB , tcdA , cdtA , and cdtB ; and these strains carried the corresponding downregulator gene tcdC , with an 18-bp deletion. PFGE was performed on 17 isolates, and one main pattern was observed. Analysis of the ribotyping data showed similar results. Conclusion The above findings represent the clonal spread of C . difficile in our institution, which mainly includes the NAP1/027 strain. This is the first report of C . difficile ribotype NAP1/027 in Mexico.