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Molecular analysis of Clostridium difficile at a university teaching hospital in Japan: a shift in the predominant type over a five-year period

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Abstract

Clostridium difficile isolates recovered from patients admitted to a teaching hospital in Japan over a 5-year period were analyzed. Two molecular typing systems, PCR ribotyping and pulsed-field gel electrophoresis (PFGE) analysis, were used. Twenty-six PCR ribotypes were found among the 148 isolates. The predominant type at our hospital appeared to shift during the study period, from PCR ribotype a in 2000 (15/33, 45%) to PCR ribotype f in 2004 (18/28, 64%). By using PFGE with thiourea added to both the gel and running buffer, all 148 Clostridium difficile isolates were successfully classified into 37 types and 61 subtypes. The PCR ribotype f isolates were further classified into four types and 11 subtypes by PFGE. The PFGE patterns of the 11 subtypes differed from each other by only 1 to 4 bands, suggesting that these differences might reflect genetic changes during patient-to-patient transmission over the 5-year period analyzed, and that PCR ribotype f isolates might be outbreak-related. In addition, the PCR ribotype f was identical to the PCR ribotype designated smz, which is reported to have caused multiple outbreaks in Japan. These results confirmed that PCR ribotype f (type smz) has specific virulence or survival factors that make it more likely to cause nosocomial outbreaks at Japanese hospitals. PCR ribotype 027, which has been reported to have caused recent outbreaks in North America and Europe, was recovered from one patient in this study; however, this strain was community-acquired. Our findings emphasize the importance of monitoring specific strains to control and prevent nosocomial infection.

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Acknowledgement

We would like to thank G. E. Killgore of the Centers for Disease Control and Prevention, USA for providing us the 90023 strain and the reference strain NAP1/027.

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Authors and Affiliations

  1. Department of Clinical Laboratory, Tokyo Medical and Dental University Hospital, Faculty of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan

    E. Sawabe & N. Tojo

  2. Department of Microbiology and Immunology, Graduate School of Health Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan

    E. Sawabe, T. Chida & N. Okamura

  3. Department of Bacterial Pathogenesis and Infection Control, National Institute of Infectious Diseases, 4-7-1 Gakuen Musashimurayama, Tokyo, 208-0011, Japan

    H. Kato & Y. Arakawa

  4. Department of Medical Technology, Faculty of Health Sciences, Kobe University School of Medicine, 7-10-2 Tomogaoka, Suma-ku, Kobe, 654-0142, Japan

    K. Osawa

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  1. E. Sawabe
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  2. H. Kato
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  3. K. Osawa
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Correspondence to E. Sawabe.

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Sawabe, E., Kato, H., Osawa, K. et al. Molecular analysis of Clostridium difficile at a university teaching hospital in Japan: a shift in the predominant type over a five-year period. Eur J Clin Microbiol Infect Dis 26, 695–703 (2007). https://doi.org/10.1007/s10096-007-0355-8

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  • DOI: https://doi.org/10.1007/s10096-007-0355-8

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