Molecular epidemiology of Clostridioides difficile isolated from patients in ICU of a county-level hospital

  Objective  To understand the infection status of Clostridioides difficile in the intensive care unit (ICU) of a county-level hospital in Zhejiang, and discuss the molecular epidemiological characteristics of toxin producing strains of C. difficile.

  Methods  Stool samples were collected from the ICU patients with diarrhea in The First People′s Hospital of Wenling from December 2017 to December 2019. C. difficile isolates were subjected to polymerase chain reaction (PCR) for detection of toxin genes. PCR ribosomal typing was used for genotyping of the C. difficile strains.

  Results  A total of 355 stool samples were collected, in which 32 (9.01%) were positive for toxigenic C. difficile. Toxin gene profiling revealed that in the 32 isolates 30 (93.75%) were positive for both toxin A (tcdA) and toxin B (tcdB) (A+B+), 2 (6.25%) were toxin A negative and toxin B positive (A-B+), and 3 (9.38%) were positive for both cdtA and cdtB genes (A+B+CDT+). In adults and children with diarrhea, the differences in age, gender, peripheral blood leucocyte, liver function indicator and renal function indicator were not significant between C. difficile infection group and non-C. difficile infection group. C. difficile infection mainly occurred in summer in adults. A total of 8 groups of PCR ribotypes (RTs) were identified based on the molecular epidemiology study.

  Conclusion  The study results indicated that the incidence of C. difficile infectionin in ICU of county-level hospitals was high, so it is necessary to strengthen C. difficile infection surveillance in grassroots hospitals.