Prevalence and Genetic Diversity of Clostridium perfringens Isolates in Hospitalized Diarrheal Patients from Central China

Baoya Wang; Wenjuan Dong; Liyan Ma; Yonghui Dong; Shanmei Wang; Youhua Yuan; Qiong Ma; Junhong Xu; Wenjuan Yan; Jing Nan; Qi Zhang; Wenbo Xu; Bing Ma; Yafei Chu; Jiangfeng Zhang; Li Li; Yi Li

doi:10.2147/IDR.S338593

Prevalence and Genetic Diversity of Clostridium perfringens Isolates in Hospitalized Diarrheal Patients from Central China

Infect Drug Resist. 2021 Nov 15:14:4783-4793. doi: 10.2147/IDR.S338593. eCollection 2021.

Authors

Baoya Wang¹, Wenjuan Dong², Liyan Ma³, Yonghui Dong⁴, Shanmei Wang¹, Youhua Yuan¹, Qiong Ma¹, Junhong Xu¹, Wenjuan Yan¹, Jing Nan¹, Qi Zhang¹, Wenbo Xu¹, Bing Ma¹, Yafei Chu¹, Jiangfeng Zhang¹, Li Li¹, Yi Li¹

Affiliations

¹ Department of Clinical Microbiology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, and People's Hospital of Henan University, Zhengzhou, 450003, Henan, People's Republic of China.
² Department of Clinical Microbiology, Xicheng District Pingan Hospital, Beijing, 100035, People's Republic of China.
³ Department of Clinical Microbiology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China.
⁴ Department of Osteology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, and People's Hospital of Henan University, Zhengzhou, 450003, Henan, People's Republic of China.

Abstract

Objective: This study aimed to investigate the prevalence, genetic diversity and clinical characteristics of Clostridium perfringens isolates from hospitalized clinical diarrheal patients.

Methods: A prospective study was conducted on 1108 patients with diarrhea during hospitalization. Stool samples were cultured for C. perfringens, and the toxin genes were detected by PCR. The available clinical data of 112 patients were analyzed to study the clinical features of various isolates. Multi-locus sequence typing (MLST) was performed to assess phylogenetic relationship between different isolates.

Results: A total of 153 (13.8%) isolates were obtained from patients' stools. C. perfringens type F (49.0%) was the major toxin type in the isolates, followed by type A (n = 59, 38.6%) and type C (n = 14, 9.2%). Patients older than 50 years and those with underlying diseases of cancer, hepatobiliary system, and ulcerative colitis (UC) were more predisposed to C. perfringens type F and type A infection than to type C. The patients infected with type C experienced more severe clinical symptoms compared to those with type A infection. There was a significant association between type F^C and foodborne gastrointestinal (GI) diseases (p = 0.018), between type F^P and antibiotic-associated diarrhea (AAD) (p < 0.001), and between type A and sporadic diarrhea (SD) (p < 0.001). Phylogenetic analysis indicated that type F isolates carrying a chromosomal cpe gene mainly belonged to ST77 (6/15 isolates). Type F isolates with cpe gene on a plasmid exhibited high genetic diversity.

Conclusion: High prevalence and considerable genetic diversity of C. perfringens type F were found in clinical diarrheal patients. Elderly people and patients with cancer, hepatobiliary diseases or UC, or suspected of having food poisoning (FP) may be targeted for routine testing of C. perfringens toxin genes and may benefit from early detection of C. perfringens type C isolates that cause more severe clinical symptoms.

Keywords: Clostridium perfringens; MLST; clinical characteristics; prevalence; toxin type.

Grants and funding

This work was supported by the National Natural Science Foundation of China (82004169) and Joint Program of Henan Province and Chinese Health Committee (LHGJ20200016).