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Canadian Journal of Infectious Diseases and Medical Microbiology
Volume 2016, Article ID 8207418, 8 pages
Research Article

Characterization of Clostridium difficile Strains in British Columbia, Canada: A Shift from NAP1 Majority (2008) to Novel Strain Types (2013) in One Region

1British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, BC, Canada V5Z 4R4
2Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada V6T 2B5
3Department of Pharmacy, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada V6T 1Z3
4Island Health, Victoria, BC, Canada V6T 1Z3
5Providence Health Care, Vancouver, BC, Canada V6Z 1Y6
6Provincial Infection Control Network of British Columbia, Vancouver, BC, Canada V6H 4B1
7National Microbiology Laboratory, Winnipeg, MB, Canada R3E 3R2
8School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada V6T 1Z3

Received 28 August 2015; Accepted 24 November 2015

Copyright © 2016 Agatha N. Jassem et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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.