Ling Yuan Kong1, David W Eyre2,3, Jacques Corbeil4, Frederic Raymond4, A Sarah Walker3, Mark H Wilcox5, Derrick W Crook2,6, Sophie Michaud7, Baldwin Toye8, Eric Frost7, Nandini Dendukuri9, Ian Schiller10, Anne-Marie Bourgault1,11, Andrew Dascal12, Matthew Oughton12, Yves Longtin12, Louise Poirier13, Paul Brassard10, Nathalie Turgeon14, Rodica Gilca15, Vivian G Loo1. 1. Division of Infectious Diseases and Department of Medical Microbiology, McGill University Health Centre, Montréal, Québec, Canada. 2. Nuffield Department of Medicine, John Radcliffe Hospital, United Kingdom. 3. National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, United Kingdom. 4. Centre de recherche CHUQ, Université Laval, Québec City, Québec, Canada. 5. Department of Microbiology, Leeds Teaching Hospitals and University of Leeds, London, United Kingdom. 6. National Infection Service, Public Health England, London, United Kingdom. 7. Department of Microbiology and Infectiology, Université de Sherbrooke, Québec, Ontario. 8. Division of Microbiology, Ottawa Hospital, University of Ottawa, Ontario. 9. Technology Assessment Unit, Canada. 10. Centre for Outcomes Research, Research Institute, McGill University Health Centre, Canada. 11. Department of Microbiology, Centre Hospitalier de l'Université de Montréal, Canada. 12. Division of Infectious Diseases, Jewish General Hospital, Canada. 13. Department of Microbiology, Hôpital Maisonneuve-Rosemont, Montréal, Canada. 14. Department of Microbiology, Centre Hospitalier Universitaire de Québec, Hôtel-Dieu de Québec, Canada. 15. Québec Institute of Public Health, Québec City, Canada.
Abstract
Background: Whole genome sequencing (WGS) studies can enhance our understanding of the role of patients with asymptomatic Clostridium difficile colonization in transmission. Methods: Isolates obtained from patients with Clostridium difficile infection (CDI) and colonization identified in a study conducted during 2006-2007 at 6 Canadian hospitals underwent typing by pulsed-field gel electrophoresis, multilocus sequence typing, and WGS. Isolates from incident CDI cases not in the initial study were also sequenced where possible. Ward movement and typing data were combined to identify plausible donors for each CDI case, as defined by shared time and space within predefined limits. Proportions of plausible donors for CDI cases that were colonized, infected, or both were examined. Results: Five hundred fifty-four isolates were sequenced successfully, 353 from colonized patients and 201 from CDI cases. The NAP1/027/ST1 strain was the most common strain, found in 124 (62%) of infected and 92 (26%) of colonized patients. A donor with a plausible ward link was found for 81 CDI cases (40%) using WGS with a threshold of ≤2 single nucleotide polymorphisms to determine relatedness. Sixty-five (32%) CDI cases could be linked to both infected and colonized donors. Exclusive linkages to infected and colonized donors were found for 28 (14%) and 12 (6%) CDI cases, respectively. Conclusions: Colonized patients contribute to transmission, but CDI cases are more likely linked to other infected patients than colonized patients in this cohort with high rates of the NAP1/027/ST1 strain, highlighting the importance of local prevalence of virulent strains in determining transmission dynamics.
Background: Whole genome sequencing (WGS) studies can enhance our understanding of the role of patients with asymptomatic Clostridium difficile colonization in transmission. Methods: Isolates obtained from patients with Clostridium difficile infection (CDI) and colonization identified in a study conducted during 2006-2007 at 6 Canadian hospitals underwent typing by pulsed-field gel electrophoresis, multilocus sequence typing, and WGS. Isolates from incident CDI cases not in the initial study were also sequenced where possible. Ward movement and typing data were combined to identify plausible donors for each CDI case, as defined by shared time and space within predefined limits. Proportions of plausible donors for CDI cases that were colonized, infected, or both were examined. Results: Five hundred fifty-four isolates were sequenced successfully, 353 from colonized patients and 201 from CDI cases. The NAP1/027/ST1 strain was the most common strain, found in 124 (62%) of infected and 92 (26%) of colonized patients. A donor with a plausible ward link was found for 81 CDI cases (40%) using WGS with a threshold of ≤2 single nucleotide polymorphisms to determine relatedness. Sixty-five (32%) CDI cases could be linked to both infected and colonized donors. Exclusive linkages to infected and colonized donors were found for 28 (14%) and 12 (6%) CDI cases, respectively. Conclusions: Colonized patients contribute to transmission, but CDI cases are more likely linked to other infected patients than colonized patients in this cohort with high rates of the NAP1/027/ST1 strain, highlighting the importance of local prevalence of virulent strains in determining transmission dynamics.
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