Molecular Epidemiology and Genetic Relatedness of Clostridioides difficile Isolates in Pediatric Oncology and Transplant Patients Using Whole Genome Sequencing.

Autor:	Barbar R; Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee, USA., Brazelton JN; Department of Pathology, St Jude Children's Research Hospital, Memphis, Tennessee, USA., Carroll KC; Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA., Lewis S; Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA., Bourdas D; Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA., Tembo A; Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA., Gluck L; Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA., Hakim H; Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee, USA., Hayden RT; Department of Pathology, St Jude Children's Research Hospital, Memphis, Tennessee, USA.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2023 Feb 08; Vol. 76 (3), pp. e1071-e1078.
DOI:	10.1093/cid/ciac459
Abstrakt:	Background: The incidence of Clostridioides difficile infection (CDI) has been rising among hospitalized children, with poor understanding of genomic variability of C. difficile isolates in this population. Methods: This was a retrospective cohort study of CDI in inpatient and outpatient pediatric oncology and cell transplant patients (POTPs) in 2016 and 2017. CDI cases were identified by positive C. difficile toxin polymerase chain reaction tests. Retrieved residual stool specimens were cultured anaerobically and toxin-producing C. difficile isolates underwent whole genome sequencing (WGS) followed by core genome multilocus sequence typing. Plausible time and location epidemiologic links among the closely related strains were evaluated to identify potential transmission events. Results: Among 226 CDI episodes in 157 patients, 202 stool samples were cultured and had positive cytotoxicity tests. Sequencing identified 33 different strain types in 162 (80%) isolates. Thirty-nine (28%) patients had multiple episodes of CDI, and 31 clusters of related isolates were identified, 15 (47%) of which involved exclusively multiple specimens from the same patient. For the 16 clusters involving multiple patients, epidemiologic investigation revealed only 2 (12.5%) clusters with potential transmission events. Conclusions: WGS identified a highly diverse group of C. difficile isolates among POTPs with CDI. Although WGS identified clusters of closely related isolates in multiple patients, epidemiologic investigation of shared inpatient exposures identified potential transmission in only 2 clusters. Clostridioides difficile transmission was uncommon in this population. More than 70% of new CDI reinfections in POTPs are actually recurrences caused by a previous CDI strain. Competing Interests: Potential conflicts of interest. R. T. H. reports royalties paid to the author from Elsevier and Wiley; scientific advisory board (SAB) honorarium paid to the author from Quidel Corporation, Roche Diagnostics, T2 Diagnostics, and Inflammatix; roles as president/past president of the Pan American Society for Clinical Virology and member of the board of directors of the Clinical Laboratory and Standards Institute; and receipt of equipment, materials, drugs, medical writing, gifts, or other services from DiaSorin. K. C. C. reports grants or contracts paid to institution from Meridian Diagnostics, Bio-Rad, BD Diagnostics, Scanogen, Tufts Summit Surveillance Studies, MeMed Diagnostics, and LBT Innovations; royalties paid to author from McGraw-Hill Publishers and Elsevier; SAB honorarium paid to author from Scanogen, ThermoFisher, Cytovale, and Co-Diagnostics; and stock or stock options (funds not yet received) from Pattern Diagnostics. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. (© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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