Analysis of Clostridium difficile Isolates from Nosocomial Outbreaks at Three Hospitals in Diverse Areas of Japan

doi:10.1128/JCM.39.4.1391-1395.2001

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Journal of Clinical Microbiology, April 2001, p. 1391-1395, Vol. 39, No. 4
0095-1137/01/$04.00+0 DOI: 10.1128/JCM.39.4.1391-1395.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.

Analysis of Clostridium difficile Isolates from Nosocomial Outbreaks at Three Hospitals in Diverse Areas of Japan

Haru Kato,¹^,²^,^* Naoki Kato,² Kunitomo Watanabe,² Toshinobu Yamamoto,³ Kanzo Suzuki,³ Shiomi Ishigo,⁴ Seiko Kunihiro,⁵ Isao Nakamura,⁵ George E. Killgore,⁶ and Shinichi Nakamura¹

Department of Bacteriology, School of Medicine, Kanazawa University, Kanazawa 920-8640,¹ Institute of Anaerobic Bacteriology, Gifu University School of Medicine, Gifu 500-8705,² Nagoyashi-Koseiin Geriatric Hospital, Nagoya 465-8610,³ Ogaki Municipal Hospital, Ogaki 503-0864,⁴ and Yamaguchi Prefectural Hospital, Bofu 747-8511,⁵ Japan, and Nosocomial Pathogens Laboratory Branch, Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333⁶

Received 21 September 2000/Returned for modification 29 December 2000/Accepted 6 February 2001

Clostridium difficile isolates recovered from patients with C. difficile-associated diarrhea (CDAD) at three hospitals locatedin diverse areas of Japan were analyzed by three typing systems,PCR ribotyping, pulsed-field gel electrophoresis (PFGE), and Westernimmunoblotting. At the three hospitals examined, a single PCRribotype strain (type smz) was predominant and accounted for 22(65%) of 34, 18 (64%) of 28, and 11 (44%) of 25 isolates, respectively.All of the 51 isolates that represented PCR ribotype smz werenontypeable by PFGE because of DNA degradation. Since the typesmz strain did not react with any of the antisera against 10 differentserogroups (A, B, C, D, F, G, H, I, K, and X), we prepared a newantiserum against a type smz isolate. All 51 type smz isolatespresented identical banding patterns, reacting with the newlyprepared antiserum (designated subserogroup JP-0 of serogroupJP). These results were compared with those of a strain from ahospital outbreak that occurred in New York, which has been identifiedas type J9 by restriction enzyme analysis and type 01/A by arbitrarilyprimed PCR but was nontypeable by PFGE because of DNA degradation.This strain was reported to be epidemic at multiple hospitalsin the United States. The J9 strain represented a PCR ribotypepattern different from that of a type smz strain and was typedas subserogroup G-1 of serogroup G by immunoblot analysis. A singleoutbreak type causing nosocomial CDAD in Japan was found to bedifferent from the strain causing multiple outbreaks in the UnitedStates, even though the outbreak strains from the two countrieswere nontypeable by PFGE because of DNAdegradation.

^* Corresponding author. Mailing address: Department of Bacteriology, School of Medicine, Kanazawa University, 13-1 Takara-machi,Kanazawa 920-8640, Japan. Phone: 81-76-265-2202. Fax: 81-76-234-4230.E-mail: cato{at}med.kanazawa-u.ac.jp.

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