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The predominance and clustering of Clostridioides (Clostridium) difficile PCR ribotype 001 isolates in three hospitals in Eastern Slovakia, 2017

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Abstract

This study aimed to implement a toxigenic culture as an optional third diagnostic step for glutamate dehydrogenase (GDH)-positive and toxin A/B-negative diarrheal stool samples into a diagnostic algorithm for Clostridioides (Clostridium) difficile infection (CDI), and to characterise C. difficile isolates for epidemiological purposes. During the 5-month study, 481 diarrhoeal stool samples from three Slovak hospitals were investigated and 66 non-duplicated GDH-positive stool samples were found. Of them, 36 were also toxin A/B-positive. Twenty-three GDH-positive and toxin A/B-negative stool samples were shown subsequently to be positive following toxigenic culture (TC). Molecular characterisation of C. difficile isolates showed the predominance of PCR ribotype (RT) 001 (n = 37, 56.1%) and the occurrence of RT 176 (n = 3, 4.5%). C. difficile RT 001 isolates clustered to eight clonal complexes (CCs) using multiple-locus variable-number tandem repeats analysis (MLVA). Interestingly, one third of RT 001 isolates clustering in these CCs were cultured from toxin A/B-negative stool samples. Our observations highlight the need of use multiple step diagnostic algorithm in CDI diagnosis in order to detect all CDI cases and to avoid the spread of C. difficile in healthcare settings.

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Acknowledgements

We would like to thank all members of the ESCMID study group for Clostridium difficile (ESGCD) for their active contribution to the development and publication of the guidance documents for CDI diagnostics, prevention and treatment.

Funding

The characterisation of C. difficile isolates was supported by MH CZ–DRO, University Hospital Motol, Prague, Czech Republic 00064203.

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Authors and Affiliations

  1. Department of Microbiology, Medirex Group, Kosice, Slovakia

    Martina Krehelova & Eva Sinajová

  2. Department of Medical Microbiology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, 150 06, Prague 5, Czech Republic

    Otakar Nyč & Marcela Krutova

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  1. Martina Krehelova
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  2. Otakar Nyč
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  3. Eva Sinajová
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  4. Marcela Krutova
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Correspondence to Marcela Krutova.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Krehelova, M., Nyč, O., Sinajová, E. et al. The predominance and clustering of Clostridioides (Clostridium) difficile PCR ribotype 001 isolates in three hospitals in Eastern Slovakia, 2017. Folia Microbiol 64, 49–54 (2019). https://doi.org/10.1007/s12223-018-0629-9

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