Objective: We analyze the characteristics of Clostridioides difficile (C. difficile) infection among diarrhea patients in Kunming from 2018 to 2020 and provide evidence for follow-up surveillance and prevention. Methods: A total of 388 fecal samples of diarrhea patients from four sentinel hospitals in Yunnan Province from 2018 to 2020 were collected. Real-time quantitative PCR was used to detect the fecal toxin genes of C. difficile. The positive fecal samples isolated the bacteria, and isolates were identified by mass spectrometry. The genomic DNA of the strains was extracted for multi-locus sequence typing (MLST). The fecal toxin, strain isolation, and clinical patient characteristics, including co-infection with other pathogens, were analyzed. Results: Among the 388 fecal samples, 47 samples with positive reference genes of C. difficile were positive, with a total positive rate of 12.11%. There were 4 (8.51%) non-toxigenic and 43 (91.49%) toxigenic ones. A total of 18 strains C. difficile were isolated from 47 positive specimens, and the isolation rate of positive specimens was 38.30%. Among them, 14 strains were positive for tcdA, tcdB, tcdC, tcdR, and tcdE. All 18 strains of C. difficile were negative for binary toxins. The MLST results showed 10 sequence types (ST), including 5 strains of ST37, accounting for 27.78%; 2 strains of ST129, ST3, ST54, and ST2, respectively; and 1 strain of ST35, ST532, ST48, ST27, and ST39, respectively. Fecal toxin gene positive (tcdB+) results were statistically associated with the patient's age group and with or without fever before the visit; positive isolates were only statistically associated with the patient's age group. In addition, some C. difficile patients have co-infection with other diarrhea-related viruses. Conclusions: The infection of C. difficile in diarrhea patients in Kunming is mostly toxigenic strains, and the high diversity of strains was identified using the MLST method. Therefore, the surveillance and prevention of C. difficile should be strengthened.
Humans ; Bacterial Toxins/genetics* ; Enterotoxins/genetics* ; Clostridioides difficile/genetics* ; Multilocus Sequence Typing ; Coinfection ; Bacterial Proteins/genetics* ; China/epidemiology* ; Clostridium Infections/epidemiology* ; Diarrhea/microbiology*

Enterotoxigenic Escherichia coli (ETEC) causes neonatal and post-weaning diarrhea in pigs. In order to determine the risk factors, rectal/fecal swabs and visceral organs obtained from pig farms in two regions of South Africa were analyzed microbiologically against risk variables. Seventy-two percent of young pigs were found to be positive for ETEC toxin genes; estB (38.9%), estB/STAP (25%), and estB/LT (13.9%) were dominant. Risk factors for ETEC-diarrhea in pigs include: leaving sick piglets in a pen with healthy piglets [odds ratio (OR) = 33.52; P < 0.0001]; water spillage in pen (OR = 42.87; P < 0.0001); hypothermic piglets (OR = 7.29; P < 0.0001); runt piglets in pen with healthy littermates (OR = 3.65; P < 0.0001); and prolonged use of antibiotics (OR = 3.05; P = 0.05).
Animals ; Animals, Newborn ; Diarrhea ; epidemiology ; microbiology ; Escherichia coli ; genetics ; isolation & purification ; Escherichia coli Infections ; epidemiology ; microbiology ; veterinary ; Genes, Bacterial ; Prevalence ; Rectum ; microbiology ; Risk Factors ; South Africa ; Swine ; Swine Diseases ; epidemiology ; microbiology ; Weaning

Objective: To understand the circulation, drug resistance and molecular characteristics of Salmonella1, 4, [5], 12: i:- in human in Guangdong province. Methods:Salmonella1, 4, [5], 12: i:- isolated from diarrhea patients in Guangdong during 2007-2016 were detected for drug resistance, genes and PFGE characteristics. Results: A total of 2 960 strains Salmonella1, 4, [5], 12: i: - were isolated from human diarrhea cases during this period. The positive rates of the isolation increased year by year. The male to female ratio of the infection cases was 1.58∶1, and the infection mainly occurred in infants and young children. Except imipenem, Salmonella1, 4, [5], 12: i: - was resistant to other 17 antibiotics to some extent. The drug resistant rates to ceftazidime, cefotaxime and ciprofloxacin increased from 2011 to 2016. Multi-drug resistance was serious, for example, the multi-drug resistant strains with ASSuT accounted for 70.62% (435/616) and the multi-drug resistant strains with ACSuGSTTm accounted for 27.11% (167/616). The lack of fljA, fljB and hin genes, as well as the retaining of iroB, STM2740, STM2757 genes, resulted in the unable expression of FljBenx gene with 8 different defection profiles. There were 934 different PFGE patterns observed in 2 347 strains, which displayed a relatively large fingerprint polymorphism. The major PFGE pattern was JPXX01. GD0226, which was found in 97 strains, accounting for 4.13% (97/2 347). The PFGE patterns in 168 Salmonella1, 4, [5], 12: i: - strains were consistent with that of Salmonella typhimurium. Conclusions:Salmonella1,4,[5], 12: i: - strains has become the major serotype of Salmonella that cause diarrhea in human in Guangdong. The multi-drug resistance of Salmonella1,4, [5], 12: i: - was serious, and since the defection of fljA, fljB and hin genes, the expression of FljBenx protein failed. The PFGE results were diverse, which displayed polymorphism in inheritance.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/pharmacology* ; Child ; Child, Preschool ; China/epidemiology* ; Diarrhea/microbiology* ; Drug Resistance, Bacterial ; Electrophoresis, Gel, Pulsed-Field ; Female ; Humans ; Infant ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Salmonella Infections/prevention & control* ; Salmonella enterica/isolation & purification* ; Salmonella typhimurium ; Serogroup ; Serotyping ; Young Adult

Objective: To understand the etiological characteristics of bacterial diarrhea in different areas, including large cities, mid-sized/small cities and rural area, in China. Methods: A cross-sectional surveillance was conducted in 17 provinces of China from 2010 to 2014. The acute diarrhea outpatients were selected from clinics or hospitals in large cities, mid-sized/small cities, including rural-urban fringe zones, and rural areas. The demographical and clinical characteristics of the patients were collected by using questionnaire, and stool samples were taken from them for laboratory detection of 17 kinds of bacteria. The differences in pathogen positive rates (PPR) and pathogen spectrum across the cases from three-type areas were compared. The different infection risk in different cases were analyzed with unconditional logistic regression model. Results: In our study, we enrolled 9 253 cases from large cities, 5 138 cases from rural areas and 13 683 cases from midsized/small cites. The pathogen with largest differences in infection rate across the three-type areas was Shigella (S.) flexneri (rural area: 5.81%, mid-sized/small city: 2.78%, large city: 0.46%), followed by Aeromonas (A.) hydrophila (rural area: 2.14%, mid-sized/small city: 0.96%, large city: 0.48%). Compared with cases in large cities, the cases in mid-sized/small cities and rural areas had higher infection risks for S. flexneri (mid-sized/small city: OR=6.481, 95%CI: 4.666-9.002, rural area: OR=11.304, 95%CI: 8.018-15.938) and A. hydrophila (mid-sized/small city: OR=1.992, 95%CI:1.401-2.832, rural area: OR=4.083, 95%CI: 2.833-5.884). The constituent ratio of diarrheagenic Escherichia coli and Salmonella increased with the urbanization development, while the ratios of Shigella and A. hydrophila had an opposite trend. S. sonnei (60.00%) was the predominant serogroup of Shigella in urban infections, while S. flexneri (77.37%) was the predominant serogroup in rural infections. Conclusion: The differences in pathogen spectrum of bacterial diarrhea were obvious across large cities, mid-sized/small cities and rural areas in China, especially the differences in the infection rates of S. flexneri and A. hydrophila.
Adolescent ; Adult ; Bacterial Infections/microbiology* ; Child ; China/epidemiology* ; Cross-Sectional Studies ; Diarrhea/microbiology* ; Dysentery/epidemiology* ; Escherichia coli/pathogenicity* ; Feces/virology* ; Female ; Humans ; Male ; Middle Aged ; Prevalence ; Rural Population ; Salmonella/pathogenicity* ; Shigella/pathogenicity* ; Suburban Population ; Urban Population

OBJECTIVETo investigate the infection status and virulent genes of Aeromonas in patients with acute diarrhea in Pudong New Area, Shanghai.

METHODSIn 2012, stool samples were collected from diarrhea patients in 12 sentinel hospitals in Pudong for the detections of 13 pathogens causing diarrhea, and the detections of 5 diarrhea related virulent genes were conducted for Aeromonas isolates.

RESULTSA total of 101 patients were infected with Aeromonas in 2533 patients (4.0%). A total of 101 Aeromonas strains were isolated, including 17 Aeromonas hydrophila strains (18.8%), 44 Aeromonas veronii biovar sobria strains (52.5%) and 12 Aeromonas caviae strains (29.7%). And 44 coinfections with other pathogens were detected. Aeromonas infection mainly occurred in summer and in people aged ≥20 years. Among the patients infected with Aeromonas, 71 (70.3%) had watery diarrhea, 20 (19.8%) had vomiting and 11 (10.9%) had fever. Virulent genes detection showed that 95.0% of the Aeromonas. strains carried virulent genes, and the detection rates of hlyA, aerA, act, alt, and ast genes were 5.9%, 6.9%, 67.3%, 42.6% and 13.9%, respectively.

CONCLUSIONSHigh incidence of Aeromonas infection was found in the patients with acute diarrhea in Pudong, and a high proportion of coinfections with other pathogens was detected too. Most Aeromonas strains carried virulent genes, and the distribution varied.

Aeromonas ; genetics ; Aeromonas hydrophila ; genetics ; China ; epidemiology ; Diarrhea ; microbiology ; Gram-Negative Bacterial Infections ; epidemiology ; microbiology ; Humans ; Seasons ; Virulence ; genetics ; Young Adult

OBJECTIVETo understand the epidemiologic and etiologic characteristics of diarrheagenic Escherichia (E.) coli infections in Shenzhen.

METHODSStool samples were collected from acute diarrheal patients in four sentinel hospitals in Shenzhen and diarrheagenic E. coli strains were isolated and identified with multiplex real-time PCR. Serotyping and pulsed-field gel electrophoresis (PFGE) typing were conducted for the diarrheagenic E. coli isolates.

RESULTSA total of 74 diarrheagenic E. coli strains were isolated from 1 823 stool samples (4.06%). The patients were mainly young children aged <3 years and adults aged 20-39 years, and the infections mainly occurred during May-September of a year. Enterotoxigenic E. coli (ETEC) and enteropathognic E. coli (EPEC) were predominant (45.9% and 31.1%). Serogroups and PFGE patterns varied among the diarrheagenic E. coli isolates. However, serogroup O159 were predominant in ETEC and there were 5 clusters with ≥2 strains sharing same PFGE patterns.

CONCLUSIONSETEC and EPEC were predominant in diarrheagenic E. coli strains isolated from diarrheal patients in Shenzhen. Age and season specific characteristics of diarrheagenic E. coli infections were observed. The serotypes and PFGE patterns of diarrheagenic E. coli strains varied. Close attention should be paid to the possible ETEC outbreak.

Adult ; Child, Preschool ; China ; epidemiology ; Diarrhea ; epidemiology ; microbiology ; Disease Outbreaks ; Electrophoresis, Gel, Pulsed-Field ; Enterotoxigenic Escherichia coli ; classification ; isolation & purification ; Escherichia coli Infections ; epidemiology ; Humans ; Real-Time Polymerase Chain Reaction ; Serotyping ; Young Adult

To analyze the clinical characteristics of continuous ambulatory peritoneal dialysis (CAPD) associated peritonitis in the tertiary hospitals and to discuss the preventive and therapeutic strategy.
 Methods: The clinical characteristics, pathogens, resistance and outcomes of 126 CAPD associated peritonitis in 104 patients from Jan, 2013 to June, 2016, were retrospectively analyzed.
 Results: Among the patients, the incidence rates of abdominal pain, fever, diarrhea and emesis were 104 (82.54%), 56 (44.44%), 49 (38.89%), and 31 (23.60%), respectively. Among them, 88 patients suffered peritonitis once, other 16 patients suffered multiple peritonitis or recurrent peritonitis for 38 times. Among the 38 times, the numbers for recurrent, repeated or catheter-associated peritonitis were 2, 2, or 3, respectively. Peritoneal fluids from 103 cases were cultured, and 64 cases were positive in bacteria, with a rate of 62.14%. A total of 70 strains of bacteria were separated, including 42 strains of gram-positive bacteria, 21 strains of gram-negative bacteria, and 7 strains of fungus. The most common gram-positive pathogens were Staphylococcus epidermidis, Enterococcus faecalis and Staphylococcus haemolyticus, while Escherichia coli, Klebsiella pneumoniae and Klebsiella pneumoniae were the most common gram-negative bacteria. Candida albicans was the major fungal pathogens. Gram-positive cocci showed resistance to gentamycin, levofloxacin, moxifloxacin, vancomycin and linezolid, with a rate at 20.00%, 36.11%, 5%, 0%, and 0%, respectively. The gram-negative bacilli were resistent to cefoperazone/sulbactam, gentamycin, cephazolin, and ceftazidime, with a rate at 6.25%, 10.53%, 64.29%, and 15.38%, respectively. There were no imipenem, amikacin, piperacillin/tazobactam-resistant strains were found.
 Conclusion: The most common pathogen causing CAPD associated peritonitis is gram-positive bacteria. It is crucial to take the anti-infection therapy for CAPD associated peritonitis early. The positive rates for bacterial culture need to be enhanced through improvement of methods. At the same time, doctors could improve the outcome of CAPD associated peritonitis by adjusting the medication according to the drug sensitivity results.
Abdominal Pain ; epidemiology ; Anti-Bacterial Agents ; Bacteria ; Bacterial Infections ; epidemiology ; microbiology ; Candidiasis ; epidemiology ; Catheters ; adverse effects ; microbiology ; Diarrhea ; epidemiology ; Drug Resistance, Bacterial ; Enterococcus faecalis ; Escherichia coli ; Fever ; epidemiology ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Humans ; Imipenem ; Klebsiella pneumoniae ; Microbial Sensitivity Tests ; Mycoses ; epidemiology ; Penicillanic Acid ; analogs & derivatives ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; adverse effects ; Peritonitis ; complications ; epidemiology ; microbiology ; Piperacillin ; Piperacillin, Tazobactam Drug Combination ; Recurrence ; Retrospective Studies ; Staphylococcus epidermidis ; Staphylococcus haemolyticus ; Vomiting ; epidemiology

Diarrhea ; epidemiology ; microbiology ; Humans ; Infant ; Salmonella Infections ; epidemiology ; microbiology ; Salmonella typhimurium

OBJECTIVETo understand the distribution of virulence gene and the epidemiological characteristics of diarrheagenic Escherichia(E.) coli (DEC) from diarrheal patients in Beijing.

METHODSStool specimens from diarrheal patients were cultured which were collected from the hospitals under sentinel surveillance program, during 2012-2013. DNA was examined by real-time PCR.

RESULTS253 out of 6 370 specimens were positive for DEC detection with the rate as 4.0%. A total number of 262 DEC strains were isolated. Two different pathotypes of DEC strains with mixed infection, were isolated from 9 specimens. Different pathotypes would show the following profiles: 42.8% for enteropathogenic E. coli (EPEC) including 42.0% atypical and 0.8% typical; 38.9% for enterotoxigenic E. coli (ETEC) including 24.8% st positive, 9.9% lt positive and 4.2% st and lt both positive;15.3% for enteroaggregative E. coli(EAEC);2.7% for enteroinvasive E. coli (EIEC); one strain STEC with serotype O26:K60. ETEC had obvious characteristics on age. All kinds of DEC were isolated throughout the year with seasonal fluctuation.

CONCLUSIONDEC isolates from diarrheal patients in Beijing were dominated by EPEC and ETEC, with atypical ones accounted for the majority of EPEC. One specimen was found under mixed infection. Pathotypes DEC were found to have different age and seasonal distributions.

China ; epidemiology ; Diarrhea ; microbiology ; Enteropathogenic Escherichia coli ; genetics ; isolation & purification ; Enterotoxigenic Escherichia coli ; genetics ; isolation & purification ; Epidemics ; Escherichia coli ; genetics ; isolation & purification ; Escherichia coli Infections ; epidemiology ; microbiology ; Genotype ; Humans ; Virulence

Abdominal Pain ; diagnosis ; Acute Disease ; Adult ; Bacterial Infections ; classification ; diagnosis ; microbiology ; Body Temperature ; China ; epidemiology ; Diarrhea ; diagnosis ; microbiology ; Feces ; cytology ; Female ; Humans ; Leukocytes ; cytology ; Logistic Models ; Male ; Middle Aged ; Risk Factors ; Young Adult