Prevalence and Strain Characterization of Clostridioides (Clostridium) difficile in Representative Regions of Germany, Ghana, Tanzania and Indonesia – A Comparative Multi-Center Cross-Sectional Study

Clostridioides (Clostridium) difficile infections (CDI) are considered worldwide as emerging health threat. Uptake of C. difficile spores may result in asymptomatic carrier status or lead to CDI that could range from mild diarrhea, eventually developing into pseudomembranous colitis up to a toxic me...

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Main Authors: Mwanaisha Seugendo, Iryna Janssen, Vanessa Lang, Irene Hasibuan, Wolfgang Bohne, Paul Cooper, Rolf Daniel, Katrin Gunka, R. L. Kusumawati, Stephen E. Mshana, Lutz von Müller, Benard Okamo, Jan R. Ortlepp, Jörg Overmann, Thomas Riedel, Maja Rupnik, Ortrud Zimmermann, Uwe Groß
Format: Article
Language:English
Published: Frontiers Media S.A. 2018-08-01
Series:Frontiers in Microbiology
Subjects:
Online Access:https://www.frontiersin.org/article/10.3389/fmicb.2018.01843/full
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author Mwanaisha Seugendo
Iryna Janssen
Vanessa Lang
Irene Hasibuan
Wolfgang Bohne
Paul Cooper
Rolf Daniel
Katrin Gunka
R. L. Kusumawati
Stephen E. Mshana
Lutz von Müller
Benard Okamo
Jan R. Ortlepp
Jörg Overmann
Thomas Riedel
Maja Rupnik
Maja Rupnik
Ortrud Zimmermann
Uwe Groß
spellingShingle Mwanaisha Seugendo
Iryna Janssen
Vanessa Lang
Irene Hasibuan
Wolfgang Bohne
Paul Cooper
Rolf Daniel
Katrin Gunka
R. L. Kusumawati
Stephen E. Mshana
Lutz von Müller
Benard Okamo
Jan R. Ortlepp
Jörg Overmann
Thomas Riedel
Maja Rupnik
Maja Rupnik
Ortrud Zimmermann
Uwe Groß
Prevalence and Strain Characterization of Clostridioides (Clostridium) difficile in Representative Regions of Germany, Ghana, Tanzania and Indonesia – A Comparative Multi-Center Cross-Sectional Study
Frontiers in Microbiology
Clostridioides difficile
epidemiology
Germany
Indonesia
Africa
multi-center study
author_facet Mwanaisha Seugendo
Iryna Janssen
Vanessa Lang
Irene Hasibuan
Wolfgang Bohne
Paul Cooper
Rolf Daniel
Katrin Gunka
R. L. Kusumawati
Stephen E. Mshana
Lutz von Müller
Benard Okamo
Jan R. Ortlepp
Jörg Overmann
Thomas Riedel
Maja Rupnik
Maja Rupnik
Ortrud Zimmermann
Uwe Groß
author_sort Mwanaisha Seugendo
title Prevalence and Strain Characterization of Clostridioides (Clostridium) difficile in Representative Regions of Germany, Ghana, Tanzania and Indonesia – A Comparative Multi-Center Cross-Sectional Study
title_short Prevalence and Strain Characterization of Clostridioides (Clostridium) difficile in Representative Regions of Germany, Ghana, Tanzania and Indonesia – A Comparative Multi-Center Cross-Sectional Study
title_full Prevalence and Strain Characterization of Clostridioides (Clostridium) difficile in Representative Regions of Germany, Ghana, Tanzania and Indonesia – A Comparative Multi-Center Cross-Sectional Study
title_fullStr Prevalence and Strain Characterization of Clostridioides (Clostridium) difficile in Representative Regions of Germany, Ghana, Tanzania and Indonesia – A Comparative Multi-Center Cross-Sectional Study
title_full_unstemmed Prevalence and Strain Characterization of Clostridioides (Clostridium) difficile in Representative Regions of Germany, Ghana, Tanzania and Indonesia – A Comparative Multi-Center Cross-Sectional Study
title_sort prevalence and strain characterization of clostridioides (clostridium) difficile in representative regions of germany, ghana, tanzania and indonesia – a comparative multi-center cross-sectional study
publisher Frontiers Media S.A.
series Frontiers in Microbiology
issn 1664-302X
publishDate 2018-08-01
description Clostridioides (Clostridium) difficile infections (CDI) are considered worldwide as emerging health threat. Uptake of C. difficile spores may result in asymptomatic carrier status or lead to CDI that could range from mild diarrhea, eventually developing into pseudomembranous colitis up to a toxic megacolon that often results in high mortality. Most epidemiological studies to date have been performed in middle- and high income countries. Beside others, the use of antibiotics and the composition of the microbiome have been identified as major risk factors for the development of CDI. We therefore postulate that prevalence rates of CDI and the distribution of C. difficile strains differ between geographical regions depending on the regional use of antibiotics and food habits. A total of 593 healthy control individuals and 608 patients suffering from diarrhea in communities in Germany, Ghana, Tanzania and Indonesia were selected for a comparative multi-center cross-sectional study. The study populations were screened for the presence of C. difficile in stool samples. Cultured C. difficile strains (n = 84) were further subtyped and characterized using PCR-ribotyping, determination of toxin production, and antibiotic susceptibility testing. Prevalence rates of C. difficile varied widely between the countries. Whereas high prevalence rates were observed in symptomatic patients living in Germany and Indonesia (24.0 and 14.7%), patients from Ghana and Tanzania showed low detection rates (4.5 and 6.4%). Differences were also obvious for ribotype distribution and toxin repertoires. Toxin A+/B+ ribotypes 001/072 and 078 predominated in Germany, whereas most strains isolated from Indonesian patients belonged to toxin A+/B+ ribotype SLO160 and toxin A-/B+ ribotype 017. With 42.9–73.3%, non-toxigenic strains were most abundant in Africa, but were also found in Indonesia at a rate of 18.2%. All isolates were susceptible to vancomycin and metronidazole. Mirroring the antibiotic use, however, moxifloxacin resistance was absent in African C. difficile isolates but present in Indonesian (24.2%) and German ones (65.5%). This study showed that CDI is a global health threat with geographically different prevalence rates which might reflect distinct use of antibiotics. Significant differences for distributions of ribotypes, toxin production, and antibiotic susceptibilities were observed.
topic Clostridioides difficile
epidemiology
Germany
Indonesia
Africa
multi-center study
url https://www.frontiersin.org/article/10.3389/fmicb.2018.01843/full
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spelling doaj-741aba559da94e5abbf4ee782cc0cb582020-11-25T00:03:40ZengFrontiers Media S.A.Frontiers in Microbiology1664-302X2018-08-01910.3389/fmicb.2018.01843403443Prevalence and Strain Characterization of Clostridioides (Clostridium) difficile in Representative Regions of Germany, Ghana, Tanzania and Indonesia – A Comparative Multi-Center Cross-Sectional StudyMwanaisha Seugendo0Iryna Janssen1Vanessa Lang2Irene Hasibuan3Wolfgang Bohne4Paul Cooper5Rolf Daniel6Katrin Gunka7R. L. Kusumawati8Stephen E. Mshana9Lutz von Müller10Benard Okamo11Jan R. Ortlepp12Jörg Overmann13Thomas Riedel14Maja Rupnik15Maja Rupnik16Ortrud Zimmermann17Uwe Groß18Department of Pediatrics and Child Health, Catholic University of Health and Allied Sciences, Mwanza, TanzaniaInstitute of Medical Microbiology, University Medical Center GöttingenGöttingen, GermanyInstitute of Medical Microbiology, University Medical Center GöttingenGöttingen, GermanyInstitute of Medical Microbiology, University Medical Center GöttingenGöttingen, GermanyInstitute of Medical Microbiology, University Medical Center GöttingenGöttingen, GermanySt. Martin de Porres Hospital, Eikwe, GhanaDepartment of Genomic and Applied Microbiology, University of Göttingen, Göttingen, GermanyInstitute of Medical Microbiology, University Medical Center GöttingenGöttingen, GermanyDepartment of Microbiology, Faculty of Medicine, Universitas Sumatera Utara, Medan, IndonesiaDepartment of Medical Microbiology, Catholic University of Health and Allied Sciences, Mwanza, TanzaniaInstitute of Medical Microbiology, Saarland University, Homburg, GermanyDepartment of Medical Microbiology, Catholic University of Health and Allied Sciences, Mwanza, TanzaniaAsklepios Kliniken Schildautal, Seesen, GermanyDepartment Microbial Ecology and Diversity Research, Leibniz Institute DSMZ, Braunschweig, GermanyDepartment Microbial Ecology and Diversity Research, Leibniz Institute DSMZ, Braunschweig, Germany0Institute of Public Health Maribor, Maribor, Slovenia1Faculty of Medicine, University of Maribor, Maribor, SloveniaInstitute of Medical Microbiology, University Medical Center GöttingenGöttingen, GermanyInstitute of Medical Microbiology, University Medical Center GöttingenGöttingen, GermanyClostridioides (Clostridium) difficile infections (CDI) are considered worldwide as emerging health threat. Uptake of C. difficile spores may result in asymptomatic carrier status or lead to CDI that could range from mild diarrhea, eventually developing into pseudomembranous colitis up to a toxic megacolon that often results in high mortality. Most epidemiological studies to date have been performed in middle- and high income countries. Beside others, the use of antibiotics and the composition of the microbiome have been identified as major risk factors for the development of CDI. We therefore postulate that prevalence rates of CDI and the distribution of C. difficile strains differ between geographical regions depending on the regional use of antibiotics and food habits. A total of 593 healthy control individuals and 608 patients suffering from diarrhea in communities in Germany, Ghana, Tanzania and Indonesia were selected for a comparative multi-center cross-sectional study. The study populations were screened for the presence of C. difficile in stool samples. Cultured C. difficile strains (n = 84) were further subtyped and characterized using PCR-ribotyping, determination of toxin production, and antibiotic susceptibility testing. Prevalence rates of C. difficile varied widely between the countries. Whereas high prevalence rates were observed in symptomatic patients living in Germany and Indonesia (24.0 and 14.7%), patients from Ghana and Tanzania showed low detection rates (4.5 and 6.4%). Differences were also obvious for ribotype distribution and toxin repertoires. Toxin A+/B+ ribotypes 001/072 and 078 predominated in Germany, whereas most strains isolated from Indonesian patients belonged to toxin A+/B+ ribotype SLO160 and toxin A-/B+ ribotype 017. With 42.9–73.3%, non-toxigenic strains were most abundant in Africa, but were also found in Indonesia at a rate of 18.2%. All isolates were susceptible to vancomycin and metronidazole. Mirroring the antibiotic use, however, moxifloxacin resistance was absent in African C. difficile isolates but present in Indonesian (24.2%) and German ones (65.5%). This study showed that CDI is a global health threat with geographically different prevalence rates which might reflect distinct use of antibiotics. Significant differences for distributions of ribotypes, toxin production, and antibiotic susceptibilities were observed.https://www.frontiersin.org/article/10.3389/fmicb.2018.01843/fullClostridioides difficileepidemiologyGermanyIndonesiaAfricamulti-center study