Abstract：
Introduction. Cancer patients with Clostridioides difficile infection (CDI) are at a higher risk for adverse outcomes. In addition, a high prevalence of Clostridioides difficile asymptomatic colonization (CDAC) has been reported in this vulnerable population.Gap Statement. The molecular characteristics and potential role of CDAC in healthcare-related transmission in the cancer population have been poorly explored.Aim. We aimed to compare the molecular and genotypic characteristics of C. difficile isolates from cancer patients with CDAC and CDI.Method. We conducted a prospective cohort study of cancer patients with CDAC or CDI from a referral centre. Molecular characterization, typification and tcdC gene expression of isolates were performed.Results. The hospital-onset and community-onset healthcare facility-associated CDI rates were 4.5 cases/10 000 patient-days and 1.4 cases/1 000 admissions during the study period. Fifty-one C. difficile strains were isolated: 37 (72 %) and 14 (28 %) from patients with CDI or CDAC, respectively. All isolates from symptomatic patients were tcdA+/tcdB+, and four (10 %) were ctdA+/ctdB+. In the CDAC group, 10 (71 %) isolates were toxigenic, and none were ctdA+/ctdB+. The Δ18 in-frame tcdC deletion and two transition mutations were found in five isolates. After bacterial typing, 60 % of toxigenic isolates from asymptomatic carriers were clonal to those from patients with C. difficile-associated diarrhoea. No NAP1/027/BI strains were detected.Conclusions. We found a clonal association between C. difficile isolates from patients with CDAC and CDI. Studies are needed to evaluate the potential role of asymptomatic carriers in the dynamics of nosocomial transmission to support infection control measures and reduce the burden of CDI in high-risk groups.
摘要：
Introduction.患有艰难梭菌感染（CDI）的癌症患者发生不良结局的风险较高。此外,据报道,在该易感人群中,艰难梭菌无症状定植(CDAC)的患病率较高.差距声明。CDAC在癌症人群中医疗保健相关传播中的分子特征和潜在作用尚未得到充分研究。瞄准.我们旨在比较CDAC和CDI癌症患者的艰难梭菌分离株的分子和基因型特征。方法。我们对转诊中心的CDAC或CDI癌症患者进行了一项前瞻性队列研究。分子表征,进行了分离株的典型化和tcdC基因表达。结果。在研究期间，医院发病和社区医疗机构相关的CDI率为4.5例/10000例患者-日和1.4例/1000例入院。从CDI或CDAC患者中分离出51株艰难梭菌：37株（72％）和14株（28％），分别。所有来自有症状患者的分离株均为tcdA+/tcdB+，四个(10%)为ctdA+/ctdB+。在CDAC组中，10个(71%)分离株是产毒的，没有一个是ctdA+/ctdB+。在五个分离株中发现了Δ18框内tcdC缺失和两个过渡突变。细菌分型后,来自无症状携带者的60％的产毒分离株与艰难梭菌相关腹泻患者的分离株是克隆的。未检测到NAP1/027/BI菌株。Conclusions.我们发现CDAC和CDI患者的艰难梭菌分离株之间存在克隆关联。需要进行研究以评估无症状携带者在医院传播动力学中的潜在作用，以支持感染控制措施并减轻高危人群的CDI负担。
