title: Characterization of Clostridium difficile Strains in British Columbia, Canada: A Shift from NAP1 Majority (2008) to Novel Strain Types (2013) in One Region.
abstract: Background. Clostridium difficile is a major cause of gastrointestinal illness. Epidemic NAP1 strains contain toxins A and B, a deletion in repressor tcdC, and a binary toxin. Objectives. To determine the molecular epidemiology of C. difficile in British Columbia and compare between two time points in one region. Methods. C. difficile isolates from hospital and community laboratories (2008) and one Island Health hospital laboratory (2013) were characterized by pulsed-field gel electrophoresis, PCR-ribotyping, toxin possession, tcdC genotype, and antimicrobial susceptibility. Results. In 2008, 42.7% of isolates had NAP1 designation. Hospital-collected isolates were associated with older patients and more NAP1 types. Unlike other isolates, most NAP1 isolates possessed binary toxin and a 19 bp loss in tcdC. All isolates were susceptible to metronidazole and vancomycin. A 2013 follow-up revealed a 28.9% decrease in NAP1 isolates and 20.0% increase in isolates without NAP designation in one region. Then, community-associated cases were seen in younger patients, while NAP types were evenly distributed. Isolates without NAP designation did not cluster with a PFGE pattern or ribotype. Conclusions. Evaluation of C. difficile infections within British Columbia revealed demographic associations, epidemiological shifts, and characteristics of strain types. Continuous surveillance of C. difficile will enable detection of emerging strains.
authors.affiliation: British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, BC, Canada V5Z 4R4; Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada V6T 2B5.
authors.forename: Agatha N
authors.initials: AN
authors.lastname: Jassem
authors.affiliation: British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, BC, Canada V5Z 4R4; Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada V6T 2B5.
authors.forename: Natalie
authors.initials: N
authors.lastname: Prystajecky
authors.affiliation: British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, BC, Canada V5Z 4R4; Department of Pharmacy, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada V6T 1Z3.
authors.forename: Fawziah
authors.initials: F
authors.lastname: Marra
authors.affiliation: Island Health, Victoria, BC, Canada V6T 1Z3.
authors.forename: Pamela
authors.initials: P
authors.lastname: Kibsey
authors.affiliation: Island Health, Victoria, BC, Canada V6T 1Z3.
authors.forename: Kennard
authors.initials: K
authors.lastname: Tan
authors.affiliation: British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, BC, Canada V5Z 4R4.
authors.forename: Patricia
authors.initials: P
authors.lastname: Umlandt
authors.affiliation: British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, BC, Canada V5Z 4R4.
authors.forename: Loretta
authors.initials: L
authors.lastname: Janz
authors.affiliation: Providence Health Care, Vancouver, BC, Canada V6Z 1Y6.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Champagne
authors.affiliation: Provincial Infection Control Network of British Columbia, Vancouver, BC, Canada V6H 4B1.
authors.forename: Bruce
authors.initials: B
authors.lastname: Gamage
authors.affiliation: National Microbiology Laboratory, Winnipeg, MB, Canada R3E 3R2.
authors.forename: George R
authors.initials: GR
authors.lastname: Golding
authors.affiliation: National Microbiology Laboratory, Winnipeg, MB, Canada R3E 3R2.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Mulvey
authors.affiliation: British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, BC, Canada V5Z 4R4; School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada V6T 1Z3.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Henry
authors.affiliation: British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, BC, Canada V5Z 4R4; Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada V6T 2B5.
authors.forename: Linda M N
authors.identifier: 0000-0001-7769-6120
authors.initials: LM
authors.lastname: Hoang