title: An investigation of the subtype diversity of clinical isolates of Irish Clostridium difficile ribotypes 027 and 078 by repetitive-extragenic palindromic PCR.
abstract: A repetitive-extragenic palindromic PCR (rep-PCR) subtyping method (DiversiLab) in conjunction with ribotyping, toxinotyping and antimicrobial-susceptibility testing was used to detect subtypes within Clostridium difficile ribotypes 027 and 078. Clinical isolates of ribotypes 027 (toxinotype III) (n = 30) and 078 (toxinotype V) (n = 23) were provided by health-care facilities across the Republic of Ireland over 2 months in 2006 and 1 month in 2009. Ribotype 027 isolates were significantly more related to each other (9 different subtype profiles) when compared to ribotype 078 isolates (14 different profiles) (P = 0.001; cut-off >90 % similarity). Almost half of ribotype 078 isolates (45.5 %) showed no relationship to each other. The clonality of ribotype 027 isolates suggests effective adaptation to the human niche, whereas the considerable genetic diversity within ribotype 078 isolates suggests that they may have originated from a variety of sources. Subtyping correlated well with antimicrobial susceptibility, in particular clindamycin susceptibility for ribotype 027, but diverse antimicrobial-susceptibility profiles were seen in ribotype 078 isolates, even within a single health-care facility. Between 2006 and 2009, a change in the predominant subtype of ribotype 027 was seen, with the recent clone representing half of all ribotype 027 isolates studied. This strain exhibited 89 % similarity to a rep-PCR profile of the North American NAP-1 strain.
authors: UCD Veterinary Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland.
authors: K
authors: K
authors: Solomon
authors: UCD Veterinary Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland.
authors: S
authors: S
authors: Murray
authors: Department of Clinical Microbiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors: L
authors: L
authors: Scott
authors: Department of Clinical Microbiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors: S
authors: S
authors: McDermott
authors: UCD Veterinary Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland.
authors: D
authors: D
authors: Drudy
authors: Department of Medicine for the Older Person, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.|UCD Veterinary Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland.
authors: A
authors: A
authors: Martin
authors: Department of Medicine for the Older Person, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.|UCD Veterinary Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland.
authors: C
authors: C
authors: O'Donoghue
authors: Health Protection and Surveillance Centre, Gardiner Street, Dublin 1, Ireland.|Department of Clinical Microbiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors: M
authors: M
authors: Skally
authors: Department of Clinical Microbiology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
authors: K
authors: K
authors: Burns
authors: Department of Clinical Microbiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors: L
authors: L
authors: Fenelon
authors: Department of Clinical Microbiology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.|Health Protection and Surveillance Centre, Gardiner Street, Dublin 1, Ireland.
authors: F
authors: F
authors: Fitzpatrick
authors: Department of Medicine for the Older Person, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.|UCD Veterinary Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland.
authors: L
authors: L
authors: Kyne
authors: UCD Veterinary Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland.
authors: S
authors: S
authors: Fanning
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000187:drug effects / Q000235:genetics*; D003015:Clostridium Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D004269:DNA, Bacterial / Q000235:genetics*; D024881:Drug Resistance, Bacterial; D014644:Genetic Variation; D005838:Genotype; D006761:Hospitals; D006801:Humans; D055029:Inverted Repeat Sequences; D007494:Ireland / Q000453:epidemiology; D010802:Phylogeny; D016133:Polymerase Chain Reaction / Q000379:methods*; D021521:Ribotyping; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial