Marín Mercedes, Martín Adoración, Alcolea Adela, Iglesias Cristina, Alcalá Luis, Peláez Teresa, Sánchez-Somolinos Mar, Bouza Emilio
Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Palma de Mallorca, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Enferm Infecc Microbiol Clin. 2014 Jun-Jul;32(6):355-8. doi: 10.1016/j.eimc.2013.07.004. Epub 2013 Sep 26.
Clostridium difficile ribotype 027 (Cd027) has caused outbreaks in the United States, Canada, and Europe since 2001. In Spain, the importance of Cd027 is still unknown. In 2007, we began active surveillance of Cd027 to determine its incidence in our hospital.
From January 2007 to April 2012, isolates of C. difficile by multiplex PCR were studied to detect toxin genes. Binary toxin-positive isolates were characterized using PCR-ribotyping. Cd027 were further characterized by toxino-typing, sequencing of tcdC gene, and MLVA (multilocus-variable-number-tandem-repeat-analysis).
Only 8 strains were Cd027 from 3666 isolates of C. difficile analyzed during the study period. These strains were isolated from 4 patients: a Spanish patient previously hospitalized in the UK, a pregnant laboratory technician, a British tourist, and a Spanish patient without epidemiological antecedents for acquiring Cd027. MLVA typing of Cd027 isolates revealed 4 different patterns. The first patient had 2 episodes of diarrhea caused by different Cd027. The strains from the first episode of patient 1 and the strain from patient 2 were grouped in the same clonal cluster (these cases were previously published as laboratory transmission), while strains from patients 3 and 4 were genetically unrelated to each other, and to the strains from patients 1 and 2.
We report the first finding of an autochthonous case of non-severe Cd027 infection. Our results indicate that Cd027 diarrhea is uncommon in our area, and it appears mainly as imported cases. MLVA typing enables us to distinguish different genotypes among our Cd027 isolates.
自2001年以来，艰难梭菌核糖体分型027（Cd027）已在美国、加拿大和欧洲引发疫情。在西班牙，Cd027的重要性仍不明确。2007年，我们开始对Cd027进行主动监测，以确定其在我院的发病率。
2007年1月至2012年4月，通过多重PCR对艰难梭菌分离株进行研究，以检测毒素基因。对二元毒素阳性分离株进行PCR核糖体分型鉴定。通过毒素分型、tcdC基因测序和多位点可变数目串联重复序列分析（MLVA）对Cd027进行进一步鉴定。
在研究期间分析的3666株艰难梭菌分离株中，只有8株为Cd027。这些菌株分离自4名患者：一名曾在英国住院的西班牙患者、一名怀孕的实验室技术员、一名英国游客以及一名无Cd027感染流行病学史的西班牙患者。Cd027分离株的MLVA分型显示出4种不同模式。第一名患者有2次由不同Cd027引起的腹泻发作。患者1第一次发作的菌株和患者2的菌株属于同一克隆簇（这些病例此前作为实验室传播发表），而患者3和4的菌株彼此之间以及与患者1和2的菌株在基因上不相关。
我们报告了首例非严重Cd027感染本土病例的发现。我们的结果表明，Cd027腹泻在我们地区并不常见，且主要表现为输入性病例。MLVA分型使我们能够区分我们的Cd027分离株中的不同基因型。
