Toxinotype of Clostridium difficile in Taiwan

Clostridium difficile is a pathogen highly associated with nosocomial infection; it causes diseases ranging from self-limited diarrhea to pseudomembranous colitis. Recently, the hyper-virulent strain of C. difficile has appeared in Taiwan. In addition, a C. difficile nosocomial outbreak was reported at one southern hospital. In this study, 59 strains of toxigenic C. difficile with known PCR-ribotypes were collected during 2008-2009 from eight and two hospitals from central and southern Taiwan, and characterized by toxinotyping and Clostridium difficile binary toxin (CDT) detection. Of 59 strains, 48 strains produced A+B+ toxin, and 11 produced A-B+ toxin. Among A+B+ toxin producing strains, 46 strains were toxinotype 0, 1 strain was toxinotype VI, and 1 strain was new toxinotype (toxinotype TN1). Among A-B+ toxin producing strains, 6 strains were toxinotype VIII, 3 strains were toxinotype V-like, and 2 strains belonged to a new type (toxinotype TN2). The strains of toxinotype 0 belonged to several PCR-riboytpes, whereas the strains of toxinotype VIII belonged to one PCR-ribotype, this indicated toxinotype VIII strains belonged to the same clonal origin. Six (10.2%) of 59 strains had CDT gene; among them, 2 strains were A+B+ toxin producing, 4 strains were A-B+ toxin producing. This study found that prevalence of A-B+ strains in Taiwan was similar to those in other Asian countries, but higher than those in Europe and USA. The strains of toxinotype V-like and VI in Taiwan was not reported in other Asian countries, neither the 2 new toxinotypes TN1 and TN2.