Hung Yuan-Pin, Huang I-Hsiu, Lin Hsiao-Ju, Tsai Bo-Yang, Liu Hsiao-Chieh, Liu Hsiu-Chuan, Lee Jen-Chieh, Wu Yi-Hui, Tsai Pei-Jane, Ko Wen-Chien
Department of Internal Medicine, Tainan Hospital, Ministry of Health & Welfare, Tainan, Taiwan.
Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
PLoS One. 2016 Nov 18;11(11):e0166159. doi: 10.1371/journal.pone.0166159. eCollection 2016.
Ribotypes and toxin genotypes of clinical C. difficile isolates in Taiwan are rarely reported. A prospective surveillance study from January 2011 to January 2013 was conducted at the medical wards of a district hospital in southern Taiwan. Of the first toxigenic isolates from 120 patients, 68 (56.7%) of 120 isolates possessed both tcdA and tcdB. Of 52 (43.3%) with tcdB and truncated tcdA (tcdA-/tcdB+), all were ribotype 017 and none had binary toxin or tcdC deletion. Eighteen (15%) toxigenic isolates harbored binary toxins (cdtA and cdtB) and all had tcdC deletion, including Δ39 (C184T) deletion (14 isolates), Δ18 in-frame deletion (3 isolates), and Δ18 (Δ117A) deletion (1 isolate). Eleven of 14 isolates with Δ39 (C184T) deletion belonged to the ribotype 078 family, including ribotype 127 (6 isolates), ribotype 126 (4 isolates), and ribotype 078 (1 isolate). Among 8 patients with consecutive C. difficile isolates, these isolates from 6 (75%) patients were identical, irrespective of the presence or absence of diarrhea, suggestive of persistent fecal carriage or colonization. In conclusion in southern Taiwan, ribotype 017 isolates with a tcdA-/tcdB+ genotype were not uncommon and of C. difficile isolates with binary toxin, the ribotype 078 family was predominant.
台湾临床艰难梭菌分离株的核糖型和毒素基因型鲜有报道。2011年1月至2013年1月在台湾南部一家地区医院的内科病房开展了一项前瞻性监测研究。在120例患者的首批产毒分离株中，120株中有68株（56.7%）同时具有tcdA和tcdB。在52株（43.3%）具有tcdB和截短型tcdA（tcdA-/tcdB+）的菌株中，均为核糖型017，无一株具有二元毒素或tcdC缺失。18株（15%）产毒分离株携带二元毒素（cdtA和cdtB），且均有tcdC缺失，包括Δ39（C184T）缺失（14株）、Δ18框内缺失（3株）和Δ18（Δ117A）缺失（1株）。14株具有Δ39（C184T）缺失的菌株中有11株属于核糖型078家族，包括核糖型127（6株）、核糖型126（4株）和核糖型078（1株）。在8例有连续艰难梭菌分离株的患者中，6例（75%）患者的这些分离株相同，无论有无腹泻，提示粪便持续携带或定植。总之，在台湾南部，tcdA-/tcdB+基因型的核糖型017分离株并不少见，在携带二元毒素的艰难梭菌分离株中，核糖型078家族占主导。
