Increasing prevalence of toxin A-negative, toxin B-positive isolates of Clostridium difficile in Korea: Impact on laboratory diagnosis

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Authors: Heejung Kim ; Thomas V. Riley ; Myungsook Kim ; Chang Ki Kim ; Dongeun Yong ; Kyungwon Lee ; Yunsop Chong ; Jong-Woo Park

MeSH: Anti-Bacterial Agents/pharmacology ; Bacterial Proteins/genetics ; Bacterial Proteins/metabolism* ; Bacterial Toxins/genetics ; Bacterial Toxins/metabolism* ; Clinical Laboratory Techniques ; Clostridium difficile/isolation & purification ; Clostridium difficile/pathogenicity* ; Enterocolitis, Pseudomembranous/diagnosis* ; Enterocolitis, Pseudomembranous/epidemiology ; Enterocolitis, Pseudomembranous/microbiology ; Enterotoxins/genetics ; Enterotoxins/metabolism* ; Fluoroquinolones/pharmacology ; Humans ; Korea/epidemiology ; Microbial Sensitivity Tests ; Polymerase Chain Reaction/methods ; Prevalence

Keywords: Anti-Bacterial Agents/pharmacology ; Bacterial Proteins/genetics ; Bacterial Proteins/metabolism* ; Bacterial Toxins/genetics ; Bacterial Toxins/metabolism* ; Clinical Laboratory Techniques ; Clostridium difficile/isolation & purification ; Clostridium difficile/pathogenicity* ; Enterocolitis, Pseudomembranous/diagnosis* ; Enterocolitis, Pseudomembranous/epidemiology ; Enterocolitis, Pseudomembranous/microbiology ; Enterotoxins/genetics ; Enterotoxins/metabolism* ; Fluoroquinolones/pharmacology ; Humans ; Korea/epidemiology ; Microbial Sensitivity Tests ; Polymerase Chain Reaction/methods ; Prevalence

Abstract: Of 462 Korean Clostridium difficile isolates, 77.5% were toxin B positive but 21.4% were toxin A negative (A(-) B(+)). The binary toxin gene was detected in nine isolates. A higher fluoroquinolone resistance of A(-) B(+) strains may contribute to the increase of these strains. Toxin A detection alone may underdiagnose C. difficile-associated disease