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Molecular epidemiology of endemic Clostridioides difficile infection in Japan

Mitsutoshi Senoh1, Haru Kato2

  • 1Department of Bacteriology II, National Institute of Infectious Diseases, Tokyo, Japan.

Anaerobe
|January 6, 2022
PubMed

Insights

Molecular epidemiology of Clostridioides difficile infection (CDI) in Japan reveals stable prevalent PCR-ribotypes since the late 1990s. Antimicrobial resistance patterns are evolving, necessitating a nationwide surveillance system for CDI burden assessment.

Area of Science:

  • Microbiology
  • Infectious Diseases
  • Epidemiology

Background:

  • Clostridioides difficile infection (CDI) poses a significant public health challenge globally.
  • Understanding the molecular epidemiology of CDI is crucial for effective control and prevention strategies.
  • Previous studies in Japan have provided insights into C. difficile strains, but a comprehensive review is needed.

Purpose of the Study:

  • To review and synthesize the molecular epidemiology of C. difficile in Japan based on available typing analyses.
  • To identify prevalent C. difficile PCR-ribotypes and track changes in their distribution over time.
  • To assess antimicrobial resistance patterns and the emergence of specific strains in the Japanese context.

Main Methods:

  • Systematic review of published articles reporting C. difficile typing analysis in Japan.
  • Analysis of PCR-ribotyping data to determine the prevalence of different ribotypes.
  • Evaluation of antimicrobial susceptibility data associated with prevalent strains.

Main Results:

  • Major prevalent PCR-ribotypes (RT018-related, RT014, RT002, RT369, RT017) consistently accounted for over 75% of isolates since the late 1990s.
  • Observed a shift within RT018-related isolates from RT018 to RT018'' (QX239) with persistent high antimicrobial resistance.
  • RT369 replaced RT017 among toxin A-negative, toxin B-positive strains, exhibiting greater fluoroquinolone resistance. RT027 and RT078 were rare, but a 2019 nosocomial outbreak involved RT027 susceptible to moxifloxacin.

Conclusions:

  • The molecular epidemiology of CDI in Japan has remained relatively stable regarding major prevalent strains.
  • Evolving antimicrobial resistance patterns and the emergence of specific ribotypes like RT369 are notable.
  • A nationwide strain-based surveillance system is essential for a comprehensive understanding and management of CDI burden in Japan.
Keywords:
Clostridioides difficileJapanMolecular epidemiologyPCR-ribotypeRT018RT369

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