title: Update of Clostridium difficile-associated disease due to PCR ribotype 027 in Europe.
abstract: Recent outbreaks of Clostridium difficile-associated diarrhoea (CDAD) with increased severity, high relapse rate and significant mortality have been related to the emergence of a new, hypervirulent C. difficile strain in North America, Japan and Europe. Definitions have been proposed by the European Centre of Disease Prevention and Control (ECDC) to identify severe cases of CDAD and to differentiate community-acquired cases from nosocomial CDAD (http://www.ecdc.europa.eu/documents/pdf/Cl_dif_v2.pdf). CDAD is mainly known as a healthcare-associated disease, but it is also increasingly recognised as a community-associated disease. The emerging strain is referred to as North American pulsed-field type 1 (NAP1) and PCR ribotype 027. Since 2005, individual countries have developed surveillance studies to monitor the spread of this strain. C. difficile type 027 has caused outbreaks in England and Wales, Ireland, the Netherlands, Belgium, Luxembourg, and France, and has also been detected in Austria, Scotland, Switzerland, Poland and Denmark. Preliminary data indicated that type 027 was already present in historical isolates collected in Sweden between 1997 and 2001.
authors.affiliation: National Reference Laboratory for Clostridium difficile, Leiden University Medical Centre, Leiden, The Netherlands. e.j.kuijper@lumc.nl
authors.forename: E J
authors.initials: EJ
authors.lastname: Kuijper
authors.forename: B
authors.initials: B
authors.lastname: Coignard
authors.forename: J S
authors.initials: JS
authors.lastname: Brazier
authors.forename: C
authors.initials: C
authors.lastname: Suetens
authors.forename: D
authors.initials: D
authors.lastname: Drudy
authors.forename: C
authors.initials: C
authors.lastname: Wiuff
authors.forename: H
authors.initials: H
authors.lastname: Pituch
authors.forename: P
authors.initials: P
authors.lastname: Reichert
authors.forename: F
authors.initials: F
authors.lastname: Schneider
authors.forename: A F
authors.initials: AF
authors.lastname: Widmer
authors.forename: K E
authors.initials: KE
authors.lastname: Olsen
authors.forename: F
authors.initials: F
authors.lastname: Allerberger
authors.forename: D W
authors.initials: DW
authors.lastname: Notermans
authors.forename: F
authors.initials: F
authors.lastname: Barbut
authors.forename: M
authors.initials: M
authors.lastname: Delmée
authors.forename: M
authors.initials: M
authors.lastname: Wilcox
authors.forename: A
authors.initials: A
authors.lastname: Pearson
authors.forename: B C
authors.initials: BC
authors.lastname: Patel
authors.forename: D J
authors.initials: DJ
authors.lastname: Brown
authors.forename: R
authors.initials: R
authors.lastname: Frei
authors.forename: T
authors.initials: T
authors.lastname: Akerlund
authors.forename: I R
authors.initials: IR
authors.lastname: Poxton
authors.forename: P
authors.initials: P
authors.lastname: Tüll
mesh_terms: D016360:Clostridioides difficile / Q000145:classification / Q000235:genetics* / Q000302:isolation & purification*; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000382:microbiology*; D005060:Europe / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D016133:Polymerase Chain Reaction; D011159:Population Surveillance; D021521:Ribotyping / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013045:Species Specificity