Clostridioides (Clostridium) difficile in children with diarrhoea in Vietnam

Peng An Khun; Long Duc Phi; Phuong Thi Pham; Ha Thi Thu Nguyen; Quyen Thi Huyen Vu; Deirdre A Collins; Thomas V Riley

doi:10.1016/j.anaerobe.2022.102550

Clostridioides (Clostridium) difficile in children with diarrhoea in Vietnam

Anaerobe. 2022 Apr:74:102550. doi: 10.1016/j.anaerobe.2022.102550. Epub 2022 Mar 22.

Authors

Peng An Khun¹, Long Duc Phi², Phuong Thi Pham³, Ha Thi Thu Nguyen⁴, Quyen Thi Huyen Vu⁴, Deirdre A Collins⁵, Thomas V Riley⁶

Affiliations

¹ School of Biomedical Sciences, The University of Western Australia, Crawley, WA, Australia.
² Thai Binh University of Medicine and Pharmacy, Thai Binh, Viet Nam.
³ Thai Binh Paediatric Hospital, Thai Binh, Viet Nam.
⁴ Ninh Binh Women and Children's Hospital, Ninh Binh, Viet Nam.
⁵ School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.
⁶ School of Biomedical Sciences, The University of Western Australia, Crawley, WA, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia; Medical, Molecular and Forensic Sciences, Murdoch University, Murdoch, WA, Australia; PathWest Laboratory Medicine, Department of Microbiology, Nedlands, WA, Australia. Electronic address: thomas.riley@uwa.edu.au.

PMID: 35331913
DOI: 10.1016/j.anaerobe.2022.102550

Abstract

Background: Clostridioides (Clostridium) difficile commonly causes hospital-acquired infection which can range from mild diarrhoea to life-threatening toxic megacolon and even death. Reports on C. difficile infection (CDI) in Vietnam are limited, so this study was designed to evaluate the prevalence, molecular epidemiology and antimicrobial susceptibility of C. difficile isolated from children with diarrhoea in Vietnam. Infants are often colonised with C. difficile and it was hypothesised that those colonising strains would represent strains of C. difficile circulating in the hospital/region at the time, however, this was not an attempt to determine if C. difficile was the cause of the diarrhoea.

Methods: Diarrhoeal stool samples collected at two children's hospitals in northern Vietnam from October 1, 2020 to February 28, 2021 were transported to Perth, Western Australia, for culture of C. difficile and further investigations on isolates; PCR ribotyping, toxin gene profiling and antimicrobial susceptibility testing.

Results: From these hospitals, 370 diarrhoeal stool samples were collected, most from children aged 1-15 months (71.9%; 266/370). The overall prevalence of C. difficile in stool samples from children aged ≤16 years was 37.8% (140/370) and the highest prevalence was in the 2-12 months age group (52.9%; 74/140). In total, 151 isolates of C. difficile were recovered; the proportion of toxigenic isolates was 16.6% (25/151). Of the 25 toxigenic C. difficile isolates, the toxin gene profiles A⁺B⁺CDT^- and A^-B⁺CDT^- comprised 72% and 28%, respectively. The four most prevalent C. difficile ribotypes (RTs) were QX 011 (25/151), RT 010 (25/151), QX 107 (12/151) and RT 012 (11/151). All isolates were susceptible to vancomycin, metronidazole and fidaxomicin, while there was significant resistance to clindamycin (90.1%), and some to moxifloxacin (6.6%) and rifaximin (3.3%).

Conclusion: The prevalence of C. difficile in children with diarrhoea was high (37.8%) although the proportion of toxigenic strains was comparatively low. The clinical significance of any isolate needs to be determined.

Keywords: Antimicrobial resistance; C. difficile; Children; PCR ribotype; Toxin gene profile; Vietnam.

MeSH terms

Anti-Bacterial Agents / pharmacology
Anti-Bacterial Agents / therapeutic use
Child
Clostridioides
Clostridioides difficile* / genetics
Clostridium / genetics
Clostridium Infections* / drug therapy
Clostridium Infections* / epidemiology
Diarrhea / drug therapy
Diarrhea / epidemiology
Humans
Infant
Microbial Sensitivity Tests
Ribotyping
Vietnam / epidemiology

Substances

Anti-Bacterial Agents