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1.
Epidemiol Mikrobiol Imunol ; 68(1): 15-22, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31181948

RESUMO

AIMS: Clostridium difficile (C. difficile) plays a minor but important role in paediatrics. The aims of this study were to objectivise data, to show their significance in clinical practice, and to present our experience with the treatment of paediatric patients. MATERIALS AND METHODS: A retrospective study was conducted in patients (0-19 years of age) hospitalized for Clostridium difficile infection (CDI) in the Department of Paediatric Infectious Diseases, University Hospital in Brno between 2013 and 2017. Each patient was tested using a two-step diagnostic screening algorithm including immunochromatography and polymerase chain reaction assays. RESULTS: Thirty-five patients with a median age of 10.3 years (range 1-17.5 years) were enrolled in the study. Almost 70% of patients were aged between 6 and 19 years. No risk factor was identified in one patient, 41.6% of cases were patients with malignancy or inflammatory bowel disease, and 2.5% of patients had short bowel syndrome. After targeted CDI treatment, the median time to resolution of diarrhoea was 2.5 days. Metronidazole was used in more than half of cases. Five patients received fidaxomicin, which was well tolerated. Metronidazole failed in three cases. Recurrence after incomplete treatment with metronidazole occurred in one patient. Health care-associated CDI was recorded in 86% of cases. Recurrent CDI was reported in four children (two with malignancy, one with inflammatory bowel dissease, and one with short bowel syndrome). CONCLUSIONS: The course of CDI is generally mild in the paediatric population. CDI without a risk factor is rare. Paediatric patients respond well to metronidazole. Fidaxomicin was well tolerated by all patients. We prefer the treatment with fidaxomicin in high-risk groups (immunocompromised condition, inflammatory bowel disease, and short bowel syndrome).


Assuntos
Infecções por Clostridium , Clostridium difficile , Adolescente , Adulto , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Infecções por Clostridium/tratamento farmacológico , Infecções por Clostridium/epidemiologia , Infecções por Clostridium/microbiologia , Infecções por Clostridium/patologia , República Tcheca , Humanos , Lactente , Recém-Nascido , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
2.
Nat Commun ; 10(1): 2641, 2019 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-31201325

RESUMO

Epsilon toxin (Etx), a potent pore forming toxin (PFT) produced by Clostridium perfringens, is responsible for the pathogenesis of enterotoxaemia of ruminants and has been suggested to play a role in multiple sclerosis in humans. Etx is a member of the aerolysin family of ß-PFTs (aß-PFTs). While the Etx soluble monomer structure was solved in 2004, Etx pore structure has remained elusive due to the difficulty of isolating the pore complex. Here we show the cryo-electron microscopy structure of Etx pore assembled on the membrane of susceptible cells. The pore structure explains important mutant phenotypes and suggests that the double ß-barrel, a common feature of the aß-PFTs, may be an important structural element in driving efficient pore formation. These insights provide the framework for the development of novel therapeutics to prevent human and animal infections, and are relevant for nano-biotechnology applications.


Assuntos
Toxinas Bacterianas/química , Clostridium perfringens/ultraestrutura , Animais , Toxinas Bacterianas/genética , Toxinas Bacterianas/isolamento & purificação , Toxinas Bacterianas/metabolismo , Biotecnologia/métodos , Linhagem Celular , Infecções por Clostridium/microbiologia , Infecções por Clostridium/prevenção & controle , Clostridium perfringens/genética , Clostridium perfringens/metabolismo , Clostridium perfringens/patogenicidade , Microscopia Crioeletrônica , Cães , Enterotoxemia/microbiologia , Enterotoxemia/prevenção & controle , Modelos Moleculares , Mutagênese Sítio-Dirigida , Nanotecnologia/métodos , Conformação Proteica em Folha beta/genética , Multimerização Proteica/genética , Proteínas Recombinantes/química , Proteínas Recombinantes/genética , Proteínas Recombinantes/isolamento & purificação , Proteínas Recombinantes/metabolismo
3.
Gastroenterology ; 157(3): 624-636, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31220424

RESUMO

As microbiome research has moved from associative to mechanistic studies, the activities of specific microbes and their products have been investigated in the development of inflammatory bowel diseases, cancer, metabolic syndrome, and neuropsychiatric disorders. Findings from microbiome research have already been applied to the clinic, such as in fecal microbiota transplantation for treatment of recurrent Clostridium difficile infection. We review the evidence for associations between alterations in the intestinal microbiome and gastrointestinal diseases and findings from clinical trials of fecal microbiota transplantation. We discuss opportunities for treatment of other diseases with fecal microbiota transplantation, based on findings from small clinical and preclinical studies.


Assuntos
Doenças do Sistema Nervoso Central/terapia , Infecções por Clostridium/terapia , Transplante de Microbiota Fecal , Gastroenteropatias/terapia , Microbioma Gastrointestinal , Inflamação/terapia , Animais , Doenças do Sistema Nervoso Central/diagnóstico , Doenças do Sistema Nervoso Central/microbiologia , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/microbiologia , Gastroenteropatias/diagnóstico , Gastroenteropatias/microbiologia , Humanos , Inflamação/diagnóstico , Inflamação/microbiologia , Recidiva , Resultado do Tratamento
4.
BMC Infect Dis ; 19(1): 361, 2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31039738

RESUMO

BACKGROUND: Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) that is widely identified worldwide. This study aimed to investigate the phenotypic characterization and molecular typing of Clostridium difficile isolates among patients with UC at an inflammatory bowel disease clinic in Iran. METHODS: In this cross-sectional study, conducted from April 2015 to December 2015, 85 UC patients were assessed for C.difficile infection (CDI). C. difficile isolates were characterized based on their toxin profile and antimicrobial resistance pattern. Multi-locus sequence typing analysis (MLST) and PCR ribotyping were performed to define the genetic relationships between different lineages of toxigenic strains. RESULTS: The prevalence of C. difficile isolates was 31.8% (27/85) in patients, of those 15 patients (17.6%) had CDI. Three different sequence types (STs) identified based on MLST among the toxigenic isolates, that is ST54 (33.3%), ST2 (53.3%), and ST37 (13.6%). C. difficile strains were divided into four different PCR-ribotypes (012, 014, 017 and IR1). The most common ribotype was 014 accounting for 48.3% (7/15) of all strains. The strains isolated during the first episode and recurrence of CDI usually belonged to PCR ribotype 014 (ST2). A high rate of CDI recurrence (14.1%, 12/85) experienced in UC patients. Colonization of the gastrointestinal tract with non-toxigenic C. difficile strains was frequent among patients with mild disease. All C. difficile isolates were susceptible to metronidazole, and vancomycin, 86 and 67% of isolates were resistant to clindamycin and erythromycin respectively. There was no correlation between the toxin type and antibiotic resistance (p > 0.05). CONCLUSION: Overall CDI is rather prevalent in UC patients. All patients with CDI experienced moderate to severe disease and exposed to different antimicrobial and anti-inflammatory agents. Close monitoring and appropriate management including early detection and fast treatment of CDI will improve UC outcomes.


Assuntos
Infecções por Clostridium/diagnóstico , Colite Ulcerativa/diagnóstico , Fezes/microbiologia , Adulto , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Infecções por Clostridium/tratamento farmacológico , Infecções por Clostridium/microbiologia , Clostridium difficile/efeitos dos fármacos , Clostridium difficile/genética , Clostridium difficile/isolamento & purificação , Colite Ulcerativa/tratamento farmacológico , Colite Ulcerativa/microbiologia , Estudos Transversais , DNA Bacteriano/genética , DNA Bacteriano/metabolismo , Farmacorresistência Bacteriana , Feminino , Trato Gastrointestinal/microbiologia , Humanos , Modelos Logísticos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Tipagem de Sequências Multilocus , Recidiva , Ribotipagem
5.
Trop Anim Health Prod ; 51(6): 1559-1569, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31076994

RESUMO

A total of 464 samples comprising of cloacal swabs from necrotic enteritis suspected live birds (191), intestinal scrapings from dead birds with symptoms of necrotic enteritis (91), and apparently healthy birds (182) were collected from selected districts of AP. The samples were subjected to multiplex PCR for simultaneous detection of α, ß, and ß2 toxin genes and uniplex PCR for the detection of NetB gene. Multiplex PCR screening of samples reveled α toxin gene positives from (cpa) 248/282 (87.94%) necrotic enteritis suspected and 40/182 (21.97%) apparently healthy samples. Among cpa positives 142/248 (57.25%) and 3/40 (7.5%) were positive for ß2 toxin gene in necrotic enteritis suspected and apparently healthy birds respectively, indicating the involvement of C. perfringens type A, with minor pore forming toxin gene cpb2 in causing necrotic enteritis in poultry. None of the sample was positive for ß toxin gene. The present research indicates C. perfringens type A along with ß2 toxin gene was responsible for causing necrotic enteritis in broiler chickens in some parts of Andhra Pradesh in India. Phylogenetic relationship of amplified cpa and cpb2 amino acids sequences from present C. perfringens isolates were studied. The analysis reveals the sequence identity of cpb2 gene of the present isolates and variations at both nucleotide and amino acid level with the published sequences of cpb2 gene of C. perfringens isolates from different animal species of the USA, Iran, Netherlands, and Japan.


Assuntos
Galinhas , Infecções por Clostridium/veterinária , Clostridium perfringens/isolamento & purificação , Enterite/veterinária , Doenças das Aves Domésticas/microbiologia , Animais , Toxinas Bacterianas/genética , Infecções por Clostridium/microbiologia , DNA Bacteriano/química , Enterite/microbiologia , Reação em Cadeia da Polimerase Multiplex , Filogenia
6.
Emerg Microbes Infect ; 8(1): 796-807, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31138041

RESUMO

Clostridium difficile ribotype (RT) 017 is an important toxigenic C. difficile RT which, due to a deletion in the repetitive region of the tcdA gene, only produces functional toxin B. Strains belonging to this RT were initially dismissed as nonpathogenic and circulated largely undetected for almost two decades until they rose to prominence following a series of outbreaks in the early 2000s. Despite lacking a functional toxin A, C. difficile RT 017 strains have been shown subsequently to be capable of causing disease as severe as that caused by strains producing both toxins A and B. While C. difficile RT 017 strains can be found in almost every continent today, epidemiological studies suggest that the RT is endemic in Asia and that the global spread of this MLST clade 4 lineage member is a relatively recent event. C. difficile RT 017 transmission appears to be mostly from human to human with only a handful of reports of isolations from animals. An important feature of C. difficile RT 017 strains is their resistance to several antimicrobials and this has been documented as a possible factor driving multiple outbreaks in different parts of the world. This review summarizes what is currently known regarding the emergence and evolution of strains belonging to C. difficile RT 017 as well as features that have allowed it to become an RT of global importance.


Assuntos
Infecções por Clostridium/microbiologia , Clostridium difficile/genética , Evolução Molecular , Animais , Ásia/epidemiologia , Infecções por Clostridium/epidemiologia , Clostridium difficile/classificação , Clostridium difficile/isolamento & purificação , Clostridium difficile/fisiologia , Humanos , Filogenia , Ribotipagem
8.
Vet Microbiol ; 231: 1-6, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30955794

RESUMO

Neonatal porcine diarrhea (NPD) is a current problem on pig farms and is caused by several enteropathogens. Among them, Clostridioides difficile stands out due to its importance in piglets and zoonotic potential. A non-toxigenic strain of C. difficile (NTCD), named Z31, was previously tested in hamster and piglet experimental models as a strategy to prevent C. difficile infection (CDI). To evaluate the capacity of the strain Z31 to prevent CDI and NPD in one-day-old piglets on a commercial farm, 90 piglets from 16 litters received 1 × 106 spores of Z31 while 84 animals from the same litters served as controls. Animals were clinically evaluated, and fecal samples were collected 24 h after administration and submitted to A/B toxin detection and isolation of C. difficile. Stool samples were also submitted to rotavirus, Escherichia coli, and Clostridium perfringens detection. Administration of Z31 reduced the incidence of CDI in treated animals (7.8%) when compared to the control group (25.0%; P = 0.003). In animals that developed CDI, the intensity of diarrhea was lower in those that received Z31 than in the control group. Neonatal porcine diarrhea was reduced in treated animals when compared to untreated animals (P < 0.001). The present study suggests that Z31 can potentially be used to prevent CDI in piglets on commercial farms.


Assuntos
Infecções por Clostridium/prevenção & controle , Clostridium difficile/fisiologia , Clostridium difficile/patogenicidade , Diarreia/veterinária , Doenças dos Suínos/microbiologia , Animais , Animais Recém-Nascidos , Derrame de Bactérias , Infecções por Clostridium/microbiologia , Clostridium perfringens/isolamento & purificação , Diarreia/microbiologia , Diarreia/prevenção & controle , Escherichia coli Enterotoxigênica/isolamento & purificação , Fazendas , Fezes/microbiologia , Suínos , Doenças dos Suínos/prevenção & controle
9.
Phys Rev E ; 99(3-1): 032403, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30999462

RESUMO

The generalized Lotka-Volterra (gLV) equations, a classic model from theoretical ecology, describe the population dynamics of a set of interacting species. As the number of species in these systems grow in number, their dynamics become increasingly complex and intractable. We introduce steady-state reduction (SSR), a method that reduces a gLV system of many ecological species into two-dimensional subsystems that each obey gLV dynamics and whose basis vectors are steady states of the high-dimensional model. We apply this method to an experimentally-derived model of the gut microbiome in order to observe the transition between "healthy" and "diseased" microbial states. Specifically, we use SSR to investigate how fecal microbiota transplantation, a promising clinical treatment for dysbiosis, can revert a diseased microbial state to health.


Assuntos
Microbioma Gastrointestinal , Modelos Biológicos , Algoritmos , Animais , Antibacterianos/efeitos adversos , Infecções por Clostridium/etiologia , Infecções por Clostridium/microbiologia , Infecções por Clostridium/terapia , Clostridium difficile , Simulação por Computador , Transplante de Microbiota Fecal , Microbioma Gastrointestinal/efeitos dos fármacos , Humanos , Camundongos , Dinâmica Populacional
10.
Pathog Glob Health ; 113(2): 58-66, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30961444

RESUMO

Clostridium species are ubiquitous and associated with various diseases in animals and humans. However, there is little knowledge about the prevalence of their resistance to antibiotics in Iran. Therefore, the aim of this study was to determine the prevalence of antibiotic-resistant Clostridium species in Iran through a meta-analysis of eligible studies published up until December 2018. Fourteen articles on the drug resistance of Clostridium species in Iran were included in the current study following a search in PubMed, Scopus and Google Scholar databases using relevant keywords and screening based on inclusion and exclusion criteria. Antibiotic resistance rates of C. difficile to ampicillin (42.8%), ciprofloxacin (69.5%), clindamycin (84.3%), erythromycin (61.5%), gentamicin (93.5%), nalidixic acid (92.9%), tetracycline (32.5%), imipenem (39.6%), levofloxacin (93.4%), ertapenem (58.7%), piperacillin/tazobactam (56.5%), kanamycin (100%), colistin (100%), ceftazidime (76%), amikacin (76.5%), moxifloxacin (67.9%) and cefotaxime (95%) were high. In addition, resistance of C. perfringens to ampicillin (25.8%), erythromycin (32.9%), gentamicin (45.4%), nalidixic acid (52.5%), tetracycline (19.5%), penicillin (21.8%), trimethoprim-sulfamethoxazole (32.1%), amoxicillin (19.3%), imipenem (38%), cloxacillin (100%), oxacillin (45.6%), bacitracin (89.1%) and colistin (40%) was high. Metronidazole and vancomycin, as the first-line therapies, fidaxomicin, tetracyclines (except tetracycline), rifampicin and chloramphenicol can still be used for the treatment of C. difficile infections. However, the present results do not recommend the use of penicillin, bacitracin and tetracycline for the treatment of C. perfringens infections in humans and domestic animals in Iran.


Assuntos
Antibacterianos/farmacologia , Infecções por Clostridium/microbiologia , Infecções por Clostridium/veterinária , Clostridium/efeitos dos fármacos , Farmacorresistência Bacteriana , Doenças dos Animais , Animais , Clostridium/classificação , Infecções por Clostridium/epidemiologia , Humanos , Irã (Geográfico)/epidemiologia , Prevalência
11.
Lett Appl Microbiol ; 69(1): 35-40, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30958895

RESUMO

With wild rodents and insectivores being present around humans and their living, working and food production environments, it is important to gain knowledge of the zoonotic pathogens present in these animals. The enteropathogen Clostridium difficile, an opportunistic anaerobic bacteria, can be carried by both animals and humans, and is distributed globally. It is known that there is genetic overlap between human and animal sources of C. difficile. In this study, the aim was to assess the presence of C. difficile in rodents and insectivores trapped on and around pig and cattle farms in the Netherlands. In total 347 rodents and insectivores (10 different species) were trapped and 39·2% tested positive for presence of C. difficile. For all positive samples the ribotype (RT) was determined, and in total there were 13 different RTs found (in descending order of frequency: 057, 010, 029, 005, 073, 078, 015, 035, 454, 014, 058, 062, 087). Six of the RTs isolated from rodents and insectivores are known to be associated with human C. difficile infection; RT005, RT010, RT014, RT015, RT078 and RT087. The presence of rodents and insectivores in and around food production buildings (e.g. farms) could contribute to the spread of C. difficile in the human environment. In order to enable on-farm management for pathogen control, it is essential to comprehend the role of wild rodents and insectivores that could potentially affect the ecology of disease agents on farms. SIGNIFICANCE AND IMPACT OF THE STUDY: This study shows that rodents and insectivores in and around food production buildings (e.g. farms) can carry Clostridium difficile ribotypes associated with human C. difficile infection (CDI). C. difficile spores in rodent and insectivore droppings are able to survive in the environment for prolonged periods, leading to host-to-host exposure and transmission. Therefore we can state that rodent and insectivore presence on farms is a risk for zoonotic pathogen transmission of C. difficile.


Assuntos
Infecções por Clostridium/epidemiologia , Infecções por Clostridium/veterinária , Clostridium difficile/isolamento & purificação , Insetívoros/microbiologia , Roedores/microbiologia , Animais , Bovinos , Infecções por Clostridium/microbiologia , Fazendas , Humanos , Camundongos , Países Baixos/epidemiologia , Ratos , Ribotipagem , Suínos , Doenças dos Suínos/microbiologia
13.
MBio ; 10(2)2019 03 12.
Artigo em Inglês | MEDLINE | ID: mdl-30862754

RESUMO

The increasing clinical importance of human infections (frequently severe) caused by Clostridium difficile PCR ribotype 078 (RT078) was first reported in 2008. The severity of symptoms (mortality of ≤30%) and the higher proportion of infections among community and younger patients raised concerns. Farm animals, especially pigs, have been identified as RT078 reservoirs. We aimed to understand the recent changes in RT078 epidemiology by investigating a possible role for antimicrobial selection in its recent evolutionary history. Phylogenetic analysis of international RT078 genomes (isolates from 2006 to 2014, n = 400), using time-scaled, recombination-corrected, maximum likelihood phylogenies, revealed several recent clonal expansions. A common ancestor of each expansion had independently acquired a different allele of the tetracycline resistance gene tetM Consequently, an unusually high proportion (76.5%) of RT078 genomes were tetM positive. Multiple additional tetracycline resistance determinants were also identified (including efflux pump tet40), frequently sharing a high level of nucleotide sequence identity (up to 100%) with sequences found in the pig pathogen Streptococcus suis and in other zoonotic pathogens such as Campylobacter jejuni and Campylobacter coli Each RT078 tetM clonal expansion lacked geographic structure, indicating rapid, recent international spread. Resistance determinants for C. difficile infection-triggering antimicrobials, including fluoroquinolones and clindamycin, were comparatively rare in RT078. Tetracyclines are used intensively in agriculture; this selective pressure, plus rapid, international spread via the food chain, may explain the increased RT078 prevalence in humans. Our work indicates that the use of antimicrobials outside the health care environment has selected for resistant organisms, and in the case of RT078, has contributed to the emergence of a human pathogen.IMPORTANCE Clostridium difficile PCR ribotype 078 (RT078) has multiple reservoirs; many are agricultural. Since 2005, this genotype has been increasingly associated with human infections in both clinical settings and the community. Investigations of RT078 whole-genome sequences revealed that tetracycline resistance had been acquired on multiple independent occasions. Phylogenetic analysis revealed a rapid, recent increase in numbers of closely related tetracycline-resistant RT078 (clonal expansions), suggesting that tetracycline selection has strongly influenced its recent evolutionary history. We demonstrate recent international spread of emergent, tetracycline-resistant RT078. A similar tetracycline-positive clonal expansion was also identified in unrelated nontoxigenic C. difficile, suggesting that this process may be widespread and may be independent of disease-causing ability. Resistance to typical C. difficile infection-associated antimicrobials (e.g., fluoroquinolones, clindamycin) occurred only sporadically within RT078. Selective pressure from tetracycline appears to be a key factor in the emergence of this human pathogen and the rapid international dissemination that followed, plausibly via the food chain.


Assuntos
Criação de Animais Domésticos/métodos , Antibacterianos/farmacologia , Clostridium difficile/classificação , Clostridium difficile/efeitos dos fármacos , Genótipo , Seleção Genética , Tetraciclina/farmacologia , Animais , Infecções por Clostridium/epidemiologia , Infecções por Clostridium/microbiologia , Infecções por Clostridium/veterinária , Clostridium difficile/genética , Clostridium difficile/isolamento & purificação , Evolução Molecular , Epidemiologia Molecular , Reação em Cadeia da Polimerase , Ribotipagem , Suínos , Doenças dos Suínos/epidemiologia , Doenças dos Suínos/microbiologia
14.
Int J Med Microbiol ; 309(3-4): 189-193, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30879971

RESUMO

Clostridium (Clostridioides) difficile is the main cause of nosocomial diarrhoea. Ribotype 018 (RT018) has been recognized as the predominant strain responsible for C. difficile infection (CDI) in Italy, whereas in most other European countries only sporadic RT018 cases occur. Between August and October 2015, a suspected C. difficile outbreak at two associated hospitals in Southern Germany was investigated by comprehensive molecular typing. Surprisingly, RT018 was detected in 9/82 CDI patients, which has never been described before in a German outbreak. Phenotypic analysis revealed fluoroquinolone and macrolide resistance. Genetic subtyping using multiple-locus variable-number tandem-repeat analysis (MLVA) and whole genome sequencing (WGS) was performed and outbreak isolates were directly compared to sporadic German RT018 isolates and to epidemic ones from Milan, Northern Italy. Molecular typing confirmed a hospital outbreak with closely related RT018 isolates. Both, MLVA and WGS revealed high similarity of outbreak strains with epidemic isolates from Italy, but low similarity to other German isolates. Comparison between both typing strategies showed that ribotyping in combination with MLVA was appropriate to identify related isolates and clonal complexes, whereas WGS provided a better discrimination with more detailed information about the phylogenetic relationship of isolates. This is the first hospital outbreak in Germany presumably caused by cross-national transmission of an Italian epidemic RT018 strain.


Assuntos
Infecções por Clostridium/epidemiologia , Infecções por Clostridium/microbiologia , Clostridium difficile/isolamento & purificação , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Surtos de Doenças , Antibacterianos , Toxinas Bacterianas/genética , Clostridium difficile/classificação , Clostridium difficile/efeitos dos fármacos , Clostridium difficile/genética , DNA Bacteriano/genética , Diarreia/epidemiologia , Diarreia/microbiologia , Farmacorresistência Bacteriana , Genoma Bacteriano/genética , Alemanha/epidemiologia , Humanos , Testes de Sensibilidade Microbiana , Repetições Minissatélites/genética , Tipagem de Sequências Multilocus , Filogenia , Reação em Cadeia da Polimerase , Ribotipagem
15.
Anaerobe ; 56: 116-123, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30849459

RESUMO

Clostridioides difficile is a colonizer of the human gut; asymptomatic colonization has been reported to be more common in infants and is highly variable across regions even with no symptoms of diarrhea or death. Antibiotic treatment strategies might increase the antibiotic resistance of C. difficile. We performed a one-point study involving 1098 healthy infants (0-36 months) to address the deficiency of reports on C. difficile colonization in Chinese community infants. The C. difficile colonization rate was 22.8% (250/1098), and more than half of the strains (55.2%) were toxigenic isolates. Among the 138 toxigenic isolates, 111 were of the A+B+CDT- genotype, 26 strains were A-B+CDT-, and one strain was A+B+CDT+. Fifteen different PCR ribotypes were found among the 250 isolates, and PCR-ribotype HB03 appeared to be dominant type, accounting for 19.6% (49/250). High levels of resistance to antimicrobial agents were observed. Our study showed that age and hospitalization before stool collection were positively correlated with the C. difficile colonization rate, whereas the delivery term was negatively related to the colonization rate. Particular attention should be paid to the increasing resistance of C. difficile to rifamycin.


Assuntos
Portador Sadio/epidemiologia , Infecções por Clostridium/epidemiologia , Clostridium difficile/isolamento & purificação , Grupo com Ancestrais do Continente Asiático , Toxinas Bacterianas/genética , Portador Sadio/microbiologia , China/epidemiologia , Infecções por Clostridium/microbiologia , Genótipo , Voluntários Saudáveis , Humanos , Lactente , Epidemiologia Molecular , Reação em Cadeia da Polimerase , Prevalência , Ribotipagem
16.
Am J Case Rep ; 20: 268-273, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30820022

RESUMO

BACKGROUND The overuse of antibiotics in animals promotes the development of multidrug-resistance predisposing for severe polymicrobial human infections. CASE REPORT We describe a case of spontaneous clostridial myonecrosis due to ulcerative colonic infection with multidrug-resistant Salmonella enterica subsp. enterica, serotype 4,[5],12: i: -. Serotyping of the colonic Salmonella isolate in the index case and the bovine farm outbreak isolates from where the patient worked indicated they were both serotype I 4,[5],12: i: -, which is linked with a multitude of large reported disease outbreaks. Further analysis revealed that they are highly genetically related and antibiotic susceptibility testing indicated that they are phenotypically identical. CONCLUSIONS Enteritis due to human acquisition of multidrug-resistant Salmonella from cattle led to the invasion and dissemination of Clostridium septicum resulting in devastating myonecrotic disease. This highlights the ramifications of co-existence and evolution of pathogenic bacteria in animals and humans and lends support to reducing the use of antibiotics in animals.


Assuntos
Infecções por Clostridium/microbiologia , Clostridium septicum/isolamento & purificação , Farmacorresistência Bacteriana Múltipla , Músculo Esquelético/patologia , Infecções por Salmonella/microbiologia , Salmonella enterica/isolamento & purificação , Infecções por Clostridium/complicações , Infecções por Clostridium/patologia , Feminino , Humanos , Necrose , Infecções por Salmonella/complicações , Infecções por Salmonella/patologia , Adulto Jovem
17.
BMC Infect Dis ; 19(1): 232, 2019 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-30845918

RESUMO

BACKGROUND: Clostridium difficile infection (CDI) is an emerging healthcare problem in the world. The purpose of this study was to perform a systematic epidemiological research of CDI in Tongji hospital, the central of China. METHODS: Stool samples from hospitalized adults suspected of CDI were enrolled. The diagnosis of CDI were based on the combination of clinical symptoms and laboratory results. Clinical features of CDI and non-CDI patients were compared by appropriate statistical tests to determine the risk factors of CDI. Multilocus sequence typing (MLST) was employed for molecular epidemiological analysis. Susceptibility testing and relevant antimicrobial agent resistance genes were performed as well. RESULTS: From June 2016 to September 2017, 839 hospitalized adults were enrolled. Among them, 107 (12.8%, 107/839) patients were C. difficile culture positive, and 73 (8.7%, 73/839) were infected with toxigenic C. difficile (TCD), with tcdA + tcdB+ strains accounting for 90.4% (66/73) and tcdA-tcdB+ for 9.6% (7/73). Meanwhile, two TCD strains were binary toxin positive and one of them was finally identified as CD027. Severe symptoms were observed in these two cases. Multivariate analysis indicated antibiotic exposure (p = 0.001, OR = 5.035) and kidney disease (p = 0.015, OR = 8.329) significantly increased the risk of CDI. Phylogenetic tree analysis demonstrated 21 different STs, including one new ST (ST467); and the most dominant type was ST54 (35.6%, 26/73). Multidrug-resistant (MDR) TCD were 53.4% (39/73); resistance to ciprofloxacin, erythromycin, and clindamycin were > 50%. Other antibiotics showed relative efficiency and all strains were susceptible to metronidazole and vancomycin. All moxifloxacin-resistant isolates carried a mutation in GyrA (Thr82 → Ile), with one both having mutation in GyrB (Ser366 → Ala). CONCLUSIONS: Knowledge of epidemiological information for CDI is limited in China. Our finding indicated tcdA + tcdB+ C. difficile strains were the dominant for CDI in our hospital. Significant risk factors for CDI in our setting appeared to be antibiotic exposure and kidney disease. Metronidazole and vancomycin were still effective for CDI. Although no outbreak was observed, the first isolation of CD027 in center China implied the potential spread of this hypervirulent clone. Further studies are needed to enhance our understanding of the epidemiology of CDI in China.


Assuntos
Infecções por Clostridium/diagnóstico , Clostridium difficile/genética , Adolescente , Adulto , Idoso , Proteínas de Bactérias/genética , China/epidemiologia , Infecções por Clostridium/epidemiologia , Infecções por Clostridium/microbiologia , Clostridium difficile/classificação , Clostridium difficile/isolamento & purificação , DNA Girase/genética , DNA Bacteriano/genética , DNA Bacteriano/isolamento & purificação , DNA Bacteriano/metabolismo , Farmacorresistência Bacteriana/genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mutação , Filogenia , Reação em Cadeia da Polimerase/métodos , Ribotipagem , Fatores de Risco , Adulto Jovem
18.
Expert Opin Emerg Drugs ; 24(1): 17-28, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30841760

RESUMO

INTRODUCTION: Clostridium difficile or Clostridioides difficile (C. difficile) infection represents the most common cause of healthcare-associated infection. Over the last decades, the incidence and severity of C. difficile infection is rapidly increasing, with a significant impact on morbidity and mortality, and burden on health care system. Orally administered vancomycin and fidaxomicin are the therapeutic options of choice for initial C. difficile infection and fecal microbiota transplant for the recurrence infection. Furthermore, in recent years several new antibiotics with narrow-spectrum activity and low intestinal resorption have been developed, including surotomycin, cadazolid, and ridinilazol, and novel toxoid vaccines are expected to be efficacious in the prevention of C. difficile infection. Areas covered: Literature review was performed to select publications about current guidelines and phase-II/III trials on emerging drugs. These include novel antibiotics, monoclonal antibodies, vaccines, and fecal microbiota transplantation. Expert opinion: We have today a wide spectrum of promising therapeutic possibilities against infection. Pivotal future clinical trials may be crucial in developing effective strategies to optimize outcomes, mainly in high-risk population.


Assuntos
Antibacterianos/administração & dosagem , Infecções por Clostridium/tratamento farmacológico , Infecção Hospitalar/tratamento farmacológico , Infecções por Clostridium/epidemiologia , Infecções por Clostridium/microbiologia , Clostridium difficile/isolamento & purificação , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Desenvolvimento de Medicamentos/métodos , Transplante de Microbiota Fecal/métodos , Humanos , Guias de Prática Clínica como Assunto
20.
APMIS ; 127(4): 222-227, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30803047

RESUMO

Clostridioides difficile is a major cause of nosocomial infectious diarrhea in hospitalized patients throughout the world. We aimed to characterize C. difficile isolates among hospitalized patients, hospital staffs, and hospital environment samples obtained in three tertiary care hospitals of Iran with regard to their molecular types between June 2016 and November 2017. The toxigenicity of C. difficile isolates was determined by toxigenic culture and multiplex-PCR. Toxigenic C. difficile isolates collected were ribotyped using capillary gel electrophoresis-based PCR and the database of WEBRIBO (http://webribo.ages.at). Of 500 clinical and non-clinical samples, toxigenic C. difficile were identified in 35 of 250 stool samples (14%) and in 3 of 250 swabs (1.2%). The most frequently found ribotypes (RTs) were 039, AI-12, and AI-21 (15.8, 10.52, and 10.52% of all isolates, respectively). Further RTs were: 017, 001, AI-3, AI-15, AI-18, AI-10, AI-4, and PR21195 (as new ribotype). The epidemic RTs (027 and 078) seen in the Europe, North America, and Asia were completely absent in this study.


Assuntos
Infecções por Clostridium/microbiologia , Clostridium difficile/classificação , Clostridium difficile/genética , Microbiologia Ambiental , Reação em Cadeia da Polimerase Multiplex , Ribotipagem , Idoso , Idoso de 80 Anos ou mais , Toxinas Bacterianas/análise , Infecções por Clostridium/epidemiologia , Clostridium difficile/isolamento & purificação , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Diarreia/epidemiologia , Diarreia/microbiologia , Eletroforese Capilar , Estudos Epidemiológicos , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Centros de Atenção Terciária
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