3 research outputs found

    Análisis de la producción de factores de virulencia y resistencia a antibióticos en biopelícula de Clostridioides (Clostridium) difficile en infecciones recurrentes y no recurrentes.

    Get PDF
    RESUMEN: La infección por Clostridioides (Clostridium) difficile (ICD) es una de las principales causas de diarrea nosocomial a nivel mundial. Se estima que del 20 al 30% de los pacientes con ICD pueden desarrollar infección recurrente (ICD-R), y posterior a la primera recurrencia, hasta el 60% pueden desarrollar múltiples episodios. En este trabajo, se desarrolló un modelo de biopelícula de C. difficile con microbiota para evaluar diferencias en la producción de biopelícula con y sin microbiota, esporulación y susceptibilidad a antimicrobianos, expresión de genes asociados a esporulación (sigH, spo0A), quorum sensing (agrD1, and luxS), y a la adhesión y formación de biopelícula (slpA and cwp84) en una selección de aislamientos de C. difficile de pacientes con ICD-R y no recurrente (ICD-NR). Se obtuvieron 110 aislamientos de C. difficile a partir de 254 pacientes con ICD confirmada (74 con ICD-NR y 36 con ICD-R). La mayoría de los aislamientos fueron productores de biopelícula (109/110), y la mayoría fueron productores fuertes. Además, la mayoría de los aislamientos correspondió al ribotipo 027 (81.37%, 83/102). La esporulación fue mayor en el grupo de aislamientos de ICD-R en comparación con los de ICD-NR (p = 0.015). Los aislamientos de ICD-R presentaron menor susceptibilidad a vancomicina que los aislamientos de ICD-NR (27.78% [10/36] y 9.09% [6/66] respectivamente, p = 0.013). Las concentraciones mínimas inhibitorias de biopelícula a vancomicina y linezolid fueron 100 veces y 20 veces mayor respectivamente que los valores de susceptibilidad en cultivo planctónico. La expresión de sigH, spo0A, cwp84 y agrD1 fue mayor en los aislamientos de ICD-R que en los aislamientos de ICD-NR en biopelícula. Todos estos factores podrían influir en el desarrollo de la infección recurrente ABSTRACT: Clostridioides [Clostridium] difficile infection (CDI) is one of the leading causes of diarrhea associated with medical care worldwide, 20-30 % of CDI patients might develop recurrent infection, and up to 60% of patients after the first recurrence might develop further episodes. A multi-species microbiota biofilm model of C. difficile was designed to evaluate the differences in the production of biofilms with and without microbiota, sporulation, susceptibility to drugs, expression of sporulating (sigH, spo0A), quorum sensing (agrD1, and luxS), and adhesion-associated and biofilm production (slpA and cwp84) pathway genes between selected C. difficile isolates from R-CDI and non-recurrent patients (NRCDI). We obtained 102 C. difficile isolates from 254 patients with confirmed CDI (66 from NR-CDI and 36 from R-CDI). Most of the isolates were biofilm producers (100/102), and most were strongly adherent. In addition, most of the strains were ribotype 027 (81.374%, 83/102). Sporulation was higher in the R-CDI than in the NR-CDI isolates (p = 0.015). The isolates from R-CDI patients more frequently demonstrated reduced susceptibility to vancomycin than isolates of NR-CDI patients (27.78% [10/36] and 9.09% [6/66], respectively, p = 0.013). The minimum inhibitory concentrations for vancomycin and linezolid against biofilms (BMIC) were up to 100 times and 20 times higher, respectively, than the corresponding planktonic MICs. Expression of sigH, spo0A, cwp84, and agrD1 was higher in R-CDI than in NR-CDI isolates. A higher expression of sporulating pathway (sigH, spo0A), quorum sensing (agrD1), and adhesion-associated (cwp84) genes was found in R-CDI than in NR-CDI isolates. All of these factors can have effect on the recurrence of the infection

    Clinical characteristics associated with the severity of Clostridium [Clostridioides] difficile infection in a tertiary teaching hospital from Mexico

    Get PDF
    Background: Clostridium difficile infection (CDI) is a leading cause of healthcare-associated diarrhea worldwide. In this study, risk factors associated with the development of severe-complicated and recurrent outcomes in CDI patients in different age groups, including the non-elderly, were assessed in a third-level hospital. Methods: CDI cases were detected by clinical data and polymerase-chain-reaction (PCR). Clinical, demographic, epidemiological, and microbiological risk factors for CDI were evaluated. Results: During the study period, 248 out of 805 patients with nosocomial diarrhea were diagnosed with CDI and the majority were severe-complicated cases (87.90%). Female gender (OR 3.19, 95% CI 1.19e8.55, p ¼ 0.02) and lymphoma (OR 3.95, 95% CI 1.03e15.13, p ¼ 0.04) were risk factors for severe-complicated CDI. Mature adulthood (51e60 years) (OR 5.80, 95% CI 1.56e21.62, p ¼ 0.01), previous rifampicin use (OR 7.44, 95% CI 2.10e26.44, p ¼ 0.00), and neoplasm (solid malignant neoplasm or hematological malignancies) (OR 4.12, 95% CI 1.01e16.83, p ¼ 0.04) were risk factors for recurrent infection. Autoimmune disorders (OR 6.62, CI 95% 1.26e34.73, p ¼ 0.02), leukemia (OR 4.97, 95% CI 1.05e23.58, p ¼ 0.04), lymphoma (OR 3.79, 95% CI 1.03e12.07, p ¼ 0.04) and previous colistin treatment (OR 4.97, 95% CI 1.05e23.58, p ¼ 0.04) were risk factors for 30-day mortality. Conclusion: Newly identified risk factors for recurrent CDI were rifampicin treatment and age between 51 and 60 years; colistin treatment was identified as a risk factor for 30-day mortality. Previously identified risk factors for severe-complicated CDI were confirmed, but with a major impact on non-elderly patients
    corecore