Molecular epidemiology of Clostridium difficile infection in a major Chinese hospital: An underrecognized problem in Asia?

Peter Hawkey*, Clare Marriott, Wen En Liu, Zi Juan Jian, Qian Gao, Thomas Kin Wah Ling, Viola Chow, Erica So, Raphael Chan, Katie Hardy, Li Xu, Susan Manzoor

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    63 Citations (Scopus)


    Clostridium difficile infection is almost unrecognized in mainland China. We have undertaken a study in a large Chinese teaching hospital in Changsha, Hunan, China, to identify cases of C. difficile, record patient characteristics, and define the molecular epidemiology with respect to ribotype distribution and cross-infection. Between April 2009 and February 2010, we examined fecal samples from 70 hospitalized patients with diarrhea who were receiving or had received antibiotics within the previous 6 weeks. Clinical information was collected and the samples were cultured for C. difficile retrospectively. Isolates were ribotyped, and multiple-locus variable-number tandem-repeat assay (MLVA) subtyping was performed on clusters of the same ribotype. The mean age of patients from whom C. difficile was cultured was 58 years, with only 4/21 patients aged > 65 years. All patients, with a single exception, had received a third-generation cephalosporin and/or a quinolone antibiotic. Twenty-one isolates of C. difficile were recovered, and seven different ribotypes were identified, the dominant types being 017 (48%), 046 (14%), and 012 (14%). We identified two clusters of cross-infection with indistinguishable isolates of ribotype 017, with evidence of spread both within and between wards. We have identified C. difficile as a possibly significant problem, with cross-infection and a distinct ribotype distribution, in a large Chinese hospital. C. difficile may be underrecognized in China, and further epidemiological studies across the country together with the introduction of routine diagnostic testing are needed to ascertain the size of this potentially significant problem.

    Original languageEnglish
    Pages (from-to)3308-3313
    Number of pages6
    JournalJournal of Clinical Microbiology
    Issue number10
    Publication statusPublished - Oct 2013


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