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Characterisation of Clostridium difficile strains isolated from Groote Schuur Hospital, Cape Town, South Africa

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Abstract

The C. difficile infection rate in South Africa is concerning. Many strains previously isolated from diarrhetic patients at Groote Schuur Hospital were ribotype 017. This study further characterised these strains with respect to their clonal relationships, antibiotic susceptibility, toxin production and various attributes impacting on pathogen colonisation. Multilocus variable-number tandem-repeat analysis (MLVA) was used to characterise all C. difficile isolates. Antibiotic susceptibility was determined by E-test and PCR-based analysis of the ermB, gyrA and gyrB genes. Auto-aggregation of cells was measured in broth, and biofilm formation observed in 24-well plates. Toxins were measured using the Wampole C DIFF TOX A/B II kit. Most isolates belonged to the ribotype 017 group. Identical MLVA types occurred in different wards over time, and several patients were infected with identical strains. All isolates were susceptible to vancomycin and metronidazole, but some ribotype 017 isolates showed reduced metronidazole susceptibility (≥2 mg l−1). Sixty-nine percent of ribotype 017 isolates were resistant to moxifloxacin, and 94 % to erythromycin, compared to 0 % and 17 % resistance, respectively, in non-ribotype 017 isolates. The ermB gene and mutations in the gyrA and/or gyrB genes were linked to erythromycin and moxifloxacin resistance, respectively. Ribotype 017 isolates auto-aggregated more strongly than other isolates and produced lower levels of the TcdB toxin than a reference strain. Certain strains produced strong biofilms. Patient-to-patient transfer and unique infection events could cause the predominance of ribotype 017 strains in the cohort. Multi-drug resistant strains are a potential reservoir for future infections.

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Acknowledgments

The authors would like to thank Dr Yolandi Roodt and Lesley Jafta for technical assistance with the capillary gel electrophoresis experiments.

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Authors and Affiliations

  1. Department of Molecular and Cell Biology, University of Cape Town, Rondebosch Cape Town, 7700, South Africa

    B. Kullin, T. Brock, S. Reid & V. Abratt

  2. Department of Medicine, Division of Gastroenterology, University of Cape Town, Cape Town, South Africa

    N. Rajabally

  3. School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, AR, USA

    F. Anwar & G. Vedantam

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  1. B. Kullin
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Correspondence to V. Abratt.

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Funding

This study was funded by the National Research Foundation of South Africa and the South African Medical Research Council. B. Kullin acknowledges the Claude Leon Foundation and the Carnegie Corporation of New York for Postdoctoral Fellowships and an assistance grant from the European Society of Clinical Microbiology and Infectious Diseases to attend the ANAEROBE 2014 Congress. T. Brock was supported by the Equity Development Programme, UCT.

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The authors declare that they have no conflict of interest.

Ethical approval and Informed consent

The study was approved by the Ethics Committee of the University of Cape Town (HREC number: 310/2008) and included the obtaining of informed consent of patients.

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Fig. S1

Minimum spanning tree representation of MLVA data for C. difficile isolates. Unique MLVA types are represented by individual circles, coloured according to ribotype with the size of the circle representing the number of isolates per MLVA type. Circle labels indicate isolation date with the patient ward in brackets. Numbers between the circles represent the summed tandem repeats (STRDs) between isolates. Isolates with a STRD ≤ 2 are shaded and ribotype 017 strains are enclosed by a dotted line. The tree has been redrawn for ease of viewing and is not to scale (PDF 195 kb)

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Kullin, B., Brock, T., Rajabally, N. et al. Characterisation of Clostridium difficile strains isolated from Groote Schuur Hospital, Cape Town, South Africa. Eur J Clin Microbiol Infect Dis 35, 1709–1718 (2016). https://doi.org/10.1007/s10096-016-2717-6

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