A severe Clostridioides difficile ribotype 027 infection in Beijing, China, july 2024.

BACKGROUND

Clostridioides difficile ribotype (RT) 027 is particularly virulent, capable of causing severe conditions such as ileus, toxic megacolon, hypotension, or shock. Outbreaks of RT027 C. difficile are more frequently reported abroad compared to China.

METHODS

We present a case of toxic megacolon caused by an RT027 C. difficile infection and trace the source of the infectious agent using whole genome sequencing. The agar dilution approach was utilized to determine antimicrobial susceptibility.

RESULTS

Phylogenetic analysis demonstrated that the origin of this isolate was located in the same bifurcating branch of strains previously isolated in Beijing in 2012, yet it clusters within a new subcluster. The single nucleotide polymorphism (SNP) differences between this strain and other isolates from mainland China range from 1 to 16, and the SNP differences between mainland China strains and international strains within the FQR1 lineage range from 7 to 37.

CONCLUSIONS

The emergence of hypervirulent RT027 C. difficile necessitates an accurate tracing of its source. Whole genome sequencing can aid in precisely identifying origins. Although RT027 C. difficile remains primarily sporadic in China, enhanced surveillance of C. difficile and stringent hospital infection control measures is imperative.