Clostridioides (Clostridium) difficile infection burden in Japan: A multicenter prospective study

Haru Kato, Mitsutoshi Senoh, Hitoshi Honda, Tadashi Fukuda, Yasuaki Tagashira, Hiroko Horiuchi, Hiroshi Chiba, Daisuke Suzuki, Naoto Hosokawa, Hidetaka Kitazono, Yasuhiro Norisue, Hisashi Kume, Nobuaki Mori, Hideo Morikawa, Saeko Kashiwagura, Akiko Higuchi, Hideaki Kato, Makoto Nakamura, Saori Ishiguro, Sayuri MoritaHideaki Ishikawa, Takuya Watanabe, Katsuyuki Kojima, Izumi Yokomaku, Tatsuya Bando, Kayoko Toimoto, Kei Moriya, Kei Kasahara, Seigo Kitada, Junko Ogawa, Haruko Saito, Harumi Tominaga, Yousuke Shimizu, Fumi Masumoto, Kayoko Tadera, Junichi Yoshida, Tetsuya Kikuchi, Ichiro Yoshikawa, Tatsuyuki Watanabe, Masahisa Honda, Kuniko Yokote, Takao Toyokawa, Hiroko Miyazato, Mika Nakama, Cedric Mahe, Kimberly Reske, Margaret A. Olsen, Erik R. Dubberke

Research output: Contribution to journalArticlepeer-review

36 Scopus citations

Abstract

Clostridioides (Clostridium) difficile is the leading cause of healthcare-associated infectious diarrhea in the developed world. Retrospective studies have shown a lower incidence of C. difficile infection (CDI) in Japan than in Europe or North America. Prospective studies are needed to determine if this is due lack of testing for C. difficile or a true difference in CDI epidemiology. A prospective cohort study of CDI was conducted from May 2014 to May 2015 at 12 medical facilities (20 wards) in Japan. Patients with at least three diarrheal bowel movements (Bristol stool grade 6–7) in the preceding 24 h were enrolled. CDI was defined by positive result on enzyme immunoassay for toxins A/B, nucleic acid amplification test for the toxin B gene or toxigenic culture. C. difficile isolates were subjected to PCR-ribotyping (RT), slpA-sequence typing (slpA-ST), and antimicrobial susceptibility testing. The overall incidence of CDI was 7.4/10,000 patient-days (PD). The incidence was highest in the five ICU wards (22.2 CDI/10,000 PD; range: 13.9–75.5/10,000 PD). The testing frequency and CDI incidence rate were highly correlated (R2 = 0.91). Of the 146 isolates, RT018/018″ was dominant (29%), followed by types 014 (23%), 002 (12%), and 369 (11%). Among the 15 non-ICU wards, two had high CDI incidence rates (13.0 and 15.9 CDI/10,000 PD), with clusters of RT018/slpA-ST smz-02 and 018”/smz-01, respectively. Three non-RT027 or 078 binary toxin-positive isolates were found. All RT018/018” isolates were resistant to moxifloxacin, gatifloxacin, clindamycin, and erythromycin. This study identified a higher CDI incidence in Japanese hospitals than previously reported by actively identifying and testing patients with clinically significant diarrhea. This suggests numerous patients with CDI are being overlooked due to inadequate diagnostic testing in Japan.

Original languageEnglish
Article number102011
JournalAnaerobe
Volume60
DOIs
StatePublished - Dec 2019

Keywords

  • Clostridioides (Clostridium) difficile
  • Incidence rate
  • Japan
  • PCR-Ribotype 018

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