title: Choosing an appropriate bacterial typing technique for epidemiologic studies.
abstract: A wide variety of bacterial typing systems are currently in use that vary greatly with respect to the effort required, cost, reliability and ability to discriminate between bacterial strains. No one technique is optimal for all forms of investigation. We discuss the desired level of discrimination and need for a biologic basis for grouping strains of apparently different types when using bacterial typing techniques for different epidemiologic applications: 1) confirming epidemiologic linkage in outbreak investigations, 2) generating hypotheses about epidemiologic relationships between bacterial strains in the absence of epidemiologic information, and 3) describing the distributions of bacterial types and identifying determinants of those distributions. Inferences made from molecular epidemiologic studies of bacteria depend upon both the typing technique selected and the study design used; thus, choice of typing technique is pivotal for increasing our understanding of the pathogenesis and transmission, and eventual disease prevention.
authors.affiliation: Department of Epidemiology and Center for Molecular and Clinical Epidemiology of Infectious Diseases, University of Michigan School of Public Health, Ann Arbor, Michigan, USA. bfoxman@umich.edu
authors.forename: Betsy
authors.initials: B
authors.lastname: Foxman
authors.forename: Lixin
authors.initials: L
authors.lastname: Zhang
authors.forename: James S
authors.initials: JS
authors.lastname: Koopman
authors.forename: Shannon D
authors.initials: SD
authors.lastname: Manning
authors.forename: Carl F
authors.initials: CF
authors.lastname: Marrs