Epidemiology of Clostridium difficile in a County Level Hospital in China

Background: The incidence of Clostridium difficile infection (CDI) has markedly increased over the past decade. Although its epidemiology has been previously investigated in tertiary hospitals, no studies have investigated the prevalence of CDI in county level hospitals in China. Objectives: This study aimed at describing the molecular characteristics of toxigenic C. difficile isolated from a community level hospital and evaluating physicians’ knowledge on CDI. Methods: We conducted a 15-month study at a country level hospital to characterize clinical isolates of C. difficile. A total of 61 toxigenic strains were isolated including 54 strains (88.5%), with both tcdA and tcdB genes positive and the remaining positive for the tcdB gene alone. Results: No binary toxin was detected. The toxigenic strains were found to be susceptible to vancomycin and metronidazole and exhibited high levels of resistance to clindamycin, levofloxacin, erythromycin, and ciprofloxacin. The most toxigenic C. difficile isolate was obtained from the gastroenterology and infection ward. Additionally, 13 sequence types (STs) were identified; ST-54 (32.8%), ST-3 (16.4%), ST-35 (13.1%), and ST-37 (11.5%) were the most common types. Conclusions: The results of the present study indicate that CDI may be a common problem, and large-scale multicenter studies are required to reveal the actual extent of the burden of CDI in county level hospitals.