title: Emergence and spread of predominantly community-onset Clostridium difficile PCR ribotype 244 infection in Australia, 2010 to 2012.
abstract: We describe an Australia-wide Clostridium difficile outbreak in 2011 and 2012 involving the previously uncommon ribotype 244. In Western Australia, 14 of 25 cases were community-associated, 11 were detected in patients younger than 65 years, 14 presented to emergency/outpatient departments, and 14 to non-tertiary/community hospitals. Using whole genome sequencing, we confirm ribotype 244 is from the same C. difficile clade as the epidemic ribotype 027. Like ribotype 027, it produces toxins A, B, and binary toxin, however it is fluoroquinolone-susceptible and thousands of single nucleotide variants distinct from ribotype 027. Fifteen outbreak isolates from across Australia were sequenced. Despite their geographic separation, all were genetically highly related without evidence of geographic clustering, consistent with a point source, for example affecting the national food chain. Comparison with reference laboratory strains revealed the outbreak clone shared a common ancestor with isolates from the United States and United Kingdom (UK). A strain obtained in the UK was phylogenetically related to our outbreak. Follow-up of that case revealed the patient had recently returned from Australia. Our data demonstrate new C. difficile strains are an on-going threat, with potential for rapid spread. Active surveillance is needed to identify and control emerging lineages.
authors: Nuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom.
authors: D W
authors: DW
authors: Eyre
authors: L
authors: L
authors: Tracey
authors: B
authors: B
authors: Elliott
authors: C
authors: C
authors: Slimings
authors: P G
authors: PG
authors: Huntington
authors: R L
authors: RL
authors: Stuart
authors: T M
authors: TM
authors: Korman
authors: G
authors: G
authors: Kotsiou
authors: R
authors: R
authors: McCann
authors: D
authors: D
authors: Griffiths
authors: W N
authors: WN
authors: Fawley
authors: P
authors: P
authors: Armstrong
authors: K E
authors: KE
authors: Dingle
authors: A S
authors: AS
authors: Walker
authors: T E
authors: TE
authors: Peto
authors: D W
authors: DW
authors: Crook
authors: M H
authors: MH
authors: Wilcox
authors: T V
authors: TV
authors: Riley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001426:Bacterial Proteins / Q000235:genetics; D001427:Bacterial Toxins / Q000235:genetics; D016360:Clostridioides difficile / Q000235:genetics*; D021821:Communicable Diseases, Emerging / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000382:microbiology; D016680:Genome, Bacterial / Q000235:genetics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010802:Phylogeny; D020641:Polymorphism, Single Nucleotide; D011159:Population Surveillance; D015995:Prevalence; D021521:Ribotyping; D012720:Severity of Illness Index; D014904:Western Australia / Q000453:epidemiology
chemical_list: D001426:Bacterial Proteins; D001427:Bacterial Toxins