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Molecular and epidemiologic study of Clostridium difficile reveals unusual heterogeneity in clinical strains circulating in different regions in Portugal

2016-08Journal article Restricted access
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dc.contributor.authorSantos, A.
dc.contributor.authorIsidro, J.
dc.contributor.authorSilva, C.
dc.contributor.authorBoaventura, L.
dc.contributor.authorDiogo, J.
dc.contributor.authorFaustino, A.
dc.contributor.authorToscano, C.
dc.contributor.authorOleastro, M.
dc.date.accessioned2017-02-13T16:15:48Z
dc.date.available2017-09-01T00:30:13Z
dc.date.issued2016-08
dc.description.abstractClostridium difficile infection (CDI) represents a great healthcare burden in developed countries. The emergence of the epidemic PCR ribotype (RT) 027 and its acquired fluoroquinolones resistance have accentuated the need for an active surveillance of CDI. Here we report the first countrywide study of CDI in Portugal with the characterization of 498 C. difficile clinical isolates from 20 hospitals in four regions in Portugal regarding RT, virulence factors and antimicrobial susceptibility. We identified 96 RTs with marked variations between and within regions, as only six RTs appeared in all four regions. RT027 was the most frequent RT overall (18.5%) and among healthcare facility-associated isolates (19.6%), while RT014 was the most common among community-associated isolates (12%). The north showed a high RT diversity among isolates and a low moxifloxacin (MXF) resistance rate (11.9%), being the only region in which RT027 was not predominant. In contrast, the isolates from the centre presented the highest RT027 frequency, and 53.4% were resistant to MXF. Overall, MXF resistance (33.2%) was associated (p <0.001) with the presence of binary toxin genes and mutations in tcdC regardless of the RT. Both traits appeared in almost 30% of the strains. RT027 showed a reduced susceptibility to metronidazole (p <0.01), and RT126 had higher minimum inhibitory concentrations to vancomycin (p = 0.03) compared to other RTs. The present study highlights an unusual heterogeneity of RTs in Portugal, with a high frequency of hypervirulent RTs and the emergence of virulence factors in non-027 RTs, emphasizing the need for a surveillance system for CDI in Portugal.pt_PT
dc.description.sponsorshipThis work was supported by Astellas Portugal and internal funding from National Institute of Health. JI is the recipient of a fellowship from Associaçao para a Promoção da Investigação em Saúde (Grant PRO-INSA_02/2015).pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationClin Microbiol Infect. 2016 Aug;22(8):695-700. doi: 10.1016/j.cmi.2016.04.002. Epub 2016 Apr 16pt_PT
dc.identifier.doi10.1016/j.cmi.2016.04.002pt_PT
dc.identifier.issn1198-743X
dc.identifier.urihttp://hdl.handle.net/10400.18/4155
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherElsevier/European Society of Clinical Microbiology and Infectious Diseasespt_PT
dc.relation.publisherversionhttp://www.sciencedirect.com/science/article/pii/S1198743X16300593pt_PT
dc.rights.urihttp://creativecommons.org/licenses/by-nc/4.0/pt_PT
dc.subjectAgedpt_PT
dc.subjectAnti-Bacterial Agentspt_PT
dc.subjectBiodiversitypt_PT
dc.subjectClostridium difficilept_PT
dc.subjectDrug Resistance, Bacterialpt_PT
dc.subjectEnterocolitis, Pseudomembranouspt_PT
dc.subjectFemalept_PT
dc.subjectGenes, Bacterialpt_PT
dc.subjectGeographypt_PT
dc.subjectHumanspt_PT
dc.subjectMalept_PT
dc.subjectMicrobial Sensitivity Testspt_PT
dc.subjectMiddle Agedpt_PT
dc.subjectMultilocus Sequence Typingpt_PT
dc.subjectPopulation Surveillancept_PT
dc.subjectPortugalpt_PT
dc.subjectVirulence Factorspt_PT
dc.subjectInfecções Gastrointestinaispt_PT
dc.titleMolecular and epidemiologic study of Clostridium difficile reveals unusual heterogeneity in clinical strains circulating in different regions in Portugalpt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage700pt_PT
oaire.citation.startPage695pt_PT
oaire.citation.titleClinical Microbiology and Infectionpt_PT
oaire.citation.volume22(8)pt_PT
rcaap.rightsembargoedAccesspt_PT
rcaap.typearticlept_PT

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