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. 2018 Apr 30:9:845.
doi: 10.3389/fmicb.2018.00845. eCollection 2018.

Molecular Characterization of Clostridium difficil e Isolates in China From 2010 to 2015

Xiao-Shu Liu  1 , Wen-Ge Li  1 , Wen-Zhu Zhang  1 , Yuan Wu  1 , Jin-Xing Lu  1
Affiliations

Molecular Characterization of Clostridium difficil e Isolates in China From 2010 to 2015

Xiao-Shu Liu et al. Front Microbiol. .

Abstract

Clostridium difficile infection (CDI) has become a worldwide public health problem causing high mortality and a large disease burden. Molecular typing and analysis is important for surveillance and infection control of CDI. However, molecular characterization of C. difficile across China is extremely rare. Here, we report on the toxin profiles, molecular subtyping with multilocus sequence typing (MLST) and PCR ribotyping, and epidemiological characteristics of 199 C. difficile isolates collected between 2010 through 2015 from 13 participating centers across China. We identified 35 STs and 27 ribotypes (RTs) among the 199 C. difficile isolates: ST35 (15.58%), ST3 (15.08%), ST37 (12.06%), and RT017 (14.07%), RT001 (12.06%), RT012 (11.56%) are the most prevalent. One isolate with ST1 and 8 isolates with ST 11 were identified. We identified a new ST in this study, denoted ST332. The toxin profile tcdA+tcdB+tcdC+tcdR+tcdE+CDT- (65.83%) was the predominant profile. Furthermore, 11 isolates with positive binary toxin genes were discovered. According to the PCR ribotyping, one isolate with RT 027, and 6 isolates with RT 078 were confirmed. The epidemiological characteristics of C. difficile in China shows geographical differences, and both the toxin profile and molecular types exhibit great diversity across the different areas.

Keywords: Clostridium difficile; MLST; PCR-ribotyping; molecular characterization; toxin genes profile.

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Figures

FIGURE 1
FIGURE 1
Isolation distribution, toxin profile and molecular types of 199 C. difficile isolates from 13 hospitals I China (2010–2015). (A) Distribution of strains by location of the origin hospitals. (B) Distribution of ST types. (C) Distribution of toxin gene profiles. (D) Distribution of RT types.
FIGURE 2
FIGURE 2
Phylogenetic analysis and population structure of C. difficile isolates from China according to MLST results. (A) The N-j tree of 100 isolates for MLST typing. Each color corresponds to clades (yellow, clade 1; red, clade 2; green, clade 3; orange, clade 4; purple, clade 5). These five clades were similar with reported population structure of C. difficile isolates around the world. Here, clade 1 were with heterogenecity and several sub-lineages were identified. (B) The minimum spanning tree of all 199 isolates in this study for MLST typing. Each circle corresponds to ST types, the number of which is indicated for the size of circles. The lines between circles indicate the similarity between profiles (bold, 5 alleles in common; normal, 4 alleles; dotted, ≤3 alleles). The shadow in the middle identified a clonal complex, in which ST48 right in the middle is the ancestor of other types.
FIGURE 3
FIGURE 3
Geographical distribution and character of ST and RT types across China. The pie charts represent the ST distribution; the bar graphs represent the RT distribution. The predominant molecular types and composition were distinct among different locations.
See this image and copyright information in PMC

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