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Canadian Journal of Infectious Diseases and Medical Microbiology
Volume 2016, Article ID 8207418, 8 pages
http://dx.doi.org/10.1155/2016/8207418
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.

Linked References

  1. CDC, “Antibiotic resistance threats in the United States, 2013,” Centers for Disease Control and Prevention Report, 2013. View at Google Scholar
  2. M. J. Garner, C. Carson, E. J. Lingohr, A. Fazil, V. L. Edge, and J. Waddell, “An assessment of antimicrobial resistant disease threats in Canada,” PLoS ONE, vol. 10, no. 4, Article ID 0125155, 2015. View at Publisher · View at Google Scholar · View at Scopus
  3. J. J. Hunt and J. D. Ballard, “Variations in virulence and molecular biology among emerging strains of Clostridium difficile,” Microbiology and Molecular Biology Reviews, vol. 77, no. 4, pp. 567–581, 2013. View at Publisher · View at Google Scholar · View at Scopus
  4. J. M. Keller and C. M. Surawicz, “Clostridium difficile infection in the elderly,” Clinics in Geriatric Medicine, vol. 30, no. 1, pp. 79–93, 2014. View at Publisher · View at Google Scholar · View at Scopus
  5. S. Y. Tartof, K. C. Yu, R. Wei, H. F. Tseng, S. J. Jacobsen, and G. K. Rieg, “Incidence of polymerase chain reaction-diagnosed clostridium difficile in a large high-risk cohort, 2011-2012,” Mayo Clinic Proceedings, vol. 89, no. 9, pp. 1229–1238, 2014. View at Publisher · View at Google Scholar · View at Scopus
  6. M. He, F. Miyajima, P. Roberts et al., “Emergence and global spread of epidemic healthcare-associated Clostridium difficile,” Nature Genetics, vol. 45, no. 1, pp. 109–113, 2013. View at Publisher · View at Google Scholar · View at Scopus
  7. B. Dupuy, R. Govind, A. Antunes, and S. Matamouros, “Clostridium difficile toxin synthesis is negatively regulated by TcdC,” Journal of Medical Microbiology, vol. 57, no. 6, pp. 685–689, 2008. View at Publisher · View at Google Scholar · View at Scopus
  8. S. T. Cartman, M. L. Kelly, D. Heeg, J. T. Heap, and N. P. Minton, “Precise manipulation of the Clostridium difficile chromosome reveals a lack of association between the tcdC genotype and toxin production,” Applied and Environmental Microbiology, vol. 78, no. 13, pp. 4683–4690, 2012. View at Publisher · View at Google Scholar · View at Scopus
  9. R. Murray, D. Boyd, P. N. Levett, M. R. Mulvey, and M. J. Alfa, “Truncation in the tcdC region of the Clostridium difficile PathLoc of clinical isolates does not predict increased biological activity of Toxin B or Toxin A,” BMC Infectious Diseases, vol. 9, article 103, 2009. View at Publisher · View at Google Scholar · View at Scopus
  10. M. Merrigan, A. Venugopal, M. Mallozzi et al., “Human hypervirulent Clostridium difficile strains exhibit increased sporulation as well as robust toxin production,” Journal of Bacteriology, vol. 192, no. 19, pp. 4904–4911, 2010. View at Publisher · View at Google Scholar · View at Scopus
  11. D. Bakker, W. K. Smits, E. J. Kuijper, and J. Corver, “TcdC does not significantly repress toxin expression in Clostridium difficile 630ΔErm,” PLoS ONE, vol. 7, no. 8, Article ID e43247, 2012. View at Publisher · View at Google Scholar · View at Scopus
  12. L. C. McDonald, G. E. Killgore, A. Thompson et al., “An epidemic, toxin gene-variant strain of Clostridium difficile,” The New England Journal of Medicine, vol. 353, no. 23, pp. 2433–2441, 2005. View at Publisher · View at Google Scholar · View at Scopus
  13. M. Warny, J. Pepin, A. Fang et al., “Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe,” The Lancet, vol. 366, no. 9491, pp. 1079–1084, 2005. View at Publisher · View at Google Scholar · View at Scopus
  14. C. Schwan, B. Stecher, T. Tzivelekidis et al., “Clostridium difficile toxin CDT induces formation of microtubule-based protrusions and increases adherence of bacteria,” PLoS Pathogens, vol. 5, no. 10, Article ID e1000626, 2009. View at Publisher · View at Google Scholar · View at Scopus
  15. C. Gonçalves, D. Decré, F. Barbut, B. Burghoffer, and J.-C. Petit, “Prevalence and characterization of a binary toxin (actin-specific ADP-ribosyltransferase) from Clostridium difficile,” Journal of Clinical Microbiology, vol. 42, no. 5, pp. 1933–1939, 2004. View at Publisher · View at Google Scholar · View at Scopus
  16. B. Geric, S. Johnson, D. N. Gerding, M. Grabnar, and M. Rupnik, “Frequency of binary toxin genes among Clostridium difficile strains that do not produce large clostridial toxins,” Journal of Clinical Microbiology, vol. 41, no. 11, pp. 5227–5232, 2003. View at Publisher · View at Google Scholar · View at Scopus
  17. D. Lachowicz, H. Pituch, and P. Obuch-Woszczatyński, “Antimicrobial susceptibility patterns of Clostridium difficile strains belonging to different polymerase chain reaction ribotypes isolated in Poland in 2012,” Anaerobe, vol. 31, pp. 37–41, 2015. View at Publisher · View at Google Scholar · View at Scopus
  18. M. Miller, D. Gravel, M. Mulvey et al., “Health care-associated Clostridium difficile infection in Canada: patient age and infecting strain type are highly predictive of severe outcome and mortality,” Clinical Infectious Diseases, vol. 50, no. 2, pp. 194–201, 2010. View at Publisher · View at Google Scholar · View at Scopus
  19. A.-C. Labbé, L. Poirier, D. MacCannell et al., “Clostridium difficile infections in a Canadian tertiary care hospital before and during a regional epidemic associated with the BI/NAP1/027 strain,” Antimicrobial Agents and Chemotherapy, vol. 52, no. 9, pp. 3180–3187, 2008. View at Publisher · View at Google Scholar · View at Scopus
  20. S. B. Debast, M. P. Bauer, I. M. J. G. Sanders, M. H. Wilcox, and E. J. Kuijper, “Antimicrobial activity of LFF571 and three treatment agents against Clostridium difficile isolates collected for a pan-European survey in 2008: clinical and therapeutic implications,” Journal of Antimicrobial Chemotherapy, vol. 68, no. 6, pp. 1305–1311, 2013. View at Publisher · View at Google Scholar · View at Scopus
  21. J. S. Brazier, R. Raybould, B. Patel et al., “Distribution and antimicrobial susceptibility patterns of Clostridium difficile PCR ribotypes in English hospitals, 2007-08,” Euro Surveillance, vol. 13, no. 41, article 3, 2008. View at Google Scholar · View at Scopus
  22. M. P. Hensgens, A. Goorhuis, D. W. Notermans, B. H. van Benthem, and E. J. Kuijper, “Decrease of hypervirulent Clostridium difficile PCR ribotype 027 in the Netherlands,” Euro Surveillance, vol. 14, no. 45, 2009. View at Google Scholar · View at Scopus
  23. M. P. Bauer, D. W. Notermans, B. H. B. van Benthem et al., “Clostridium difficile infection in Europe: a hospital-based survey,” The Lancet, vol. 377, no. 9759, pp. 63–73, 2011. View at Publisher · View at Google Scholar · View at Scopus
  24. M. H. Wilcox, N. Shetty, W. N. Fawley et al., “Changing epidemiology of Clostridium difficile infection following the introduction of a national ribotyping-based surveillance scheme in England,” Clinical Infectious Diseases, vol. 55, no. 8, pp. 1056–1063, 2012. View at Publisher · View at Google Scholar · View at Scopus
  25. J. Freeman, M. P. Bauer, S. D. Baines et al., “The changing epidemiology of Clostridium difficile infections,” Clinical Microbiology Reviews, vol. 23, no. 3, pp. 529–549, 2010. View at Publisher · View at Google Scholar · View at Scopus
  26. F. C. Lessa, C. V. Gould, and L. C. McDonald, “Current status of Clostridium difficile infection epidemiology,” Clinical Infectious Diseases, vol. 55, supplement 2, pp. S65–S70, 2012. View at Publisher · View at Google Scholar · View at Scopus
  27. PICNet, Clostridium difficile Infection (CDI) Surveillance Report: For the Fiscal Year 2013/2014, Provincial Infection Control Network of British Columbia, 2014.
  28. T. Delate, G. Albrecht, K. Won, and A. Jackson, “Ambulatory-treated Clostridium difficile infection: a comparison of community-acquired vs. nosocomial infection,” Epidemiology and Infection, vol. 143, no. 6, pp. 1225–1235, 2015. View at Publisher · View at Google Scholar · View at Scopus
  29. S. K. Taori, A. Wroe, A. Hardie, A. P. Gibb, and I. R. Poxton, “A prospective study of community-associated Clostridium difficile infections: the role of antibiotics and co-infections,” Journal of Infection, vol. 69, no. 2, pp. 134–144, 2014. View at Publisher · View at Google Scholar · View at Scopus
  30. B.-M. Shin, S. J. Moon, Y. S. Kim, W. C. Shin, and H. M. Yoo, “Characterization of cases of Clostridium difficile infection (CDI) presenting at an emergency room: Molecular and clinical features differentiate community-onset hospital-associated and community-associated CDI in a tertiary care hospital,” Journal of Clinical Microbiology, vol. 49, no. 6, pp. 2161–2165, 2011. View at Publisher · View at Google Scholar · View at Scopus
  31. S. Naggie, J. Frederick, B. C. Pien et al., “Community-associated Clostridium difficile infection: experience of a veteran affairs medical center in southeastern USA,” Infection, vol. 38, no. 4, pp. 297–300, 2010. View at Publisher · View at Google Scholar · View at Scopus
  32. CDC, “Severe Clostridium difficile-associated disease in populations previously at low risk—four states, 2005,” Morbidity and Mortality Weekly Report, vol. 54, pp. 1201–1205, 2005. View at Google Scholar
  33. M. J. Alfa, A. Kabani, D. Lyerly et al., “Characterization of a toxin A-negative, toxin B-positive strain of Clostridium difficile responsible for a nosocomial outbreak of Clostridium difficile-associated diarrhea,” Journal of Clinical Microbiology, vol. 38, no. 7, pp. 2706–2714, 2000. View at Google Scholar · View at Scopus
  34. J. A. Karlowsky, G. G. Zhanel, G. W. Hammond et al., “Multidrug-resistant North American pulsotype 2 Clostridium difficile was the predominant toxigenic hospital-acquired strain in the province of Manitoba, Canada, in 2006-2007,” Journal of Medical Microbiology, vol. 61, no. 5, pp. 693–700, 2012. View at Publisher · View at Google Scholar · View at Scopus
  35. W. N. Fawley, C. W. Knetsch, D. R. MacCannell et al., “Development and validation of an internationally-standardized, high-resolution capillary gel-based electrophoresis PCR-ribotyping protocol for Clostridium difficile,” PLoS ONE, vol. 10, no. 2, Article ID e0118150, 2015. View at Publisher · View at Google Scholar · View at Scopus
  36. P. Spigaglia and P. Mastrantonio, “Molecular analysis of the pathogenicity locus and polymorphism in the putative negative regulator of toxin production (TcdC) among Clostridium difficile clinical isolates,” Journal of Clinical Microbiology, vol. 40, no. 9, pp. 3470–3475, 2002. View at Publisher · View at Google Scholar · View at Scopus
  37. I. Poilane, P. Cruaud, J. C. Torlotin, and A. Collignon, “Comparison of the E test to the reference agar dilution method for antibiotic susceptibility testing of Clostridium difficile,” Clinical Microbiology and Infection, vol. 6, no. 3, pp. 155–156, 2000. View at Google Scholar · View at Scopus
  38. CLSI, Performance Standards for Antimicrobial Susceptibility Testing, 23rd Informational Supplement, CLSI, Wayne, Pa, USA, 2013.
  39. EUCAST, Breakpoint Tables for Interpretation of MICs and Zone Diameters, Version 4.0, European Committee on Antimicrobial Susceptibility Testing, London, UK, 2014.
  40. H. Martin, B. Willey, D. E. Low et al., “Characterization of Clostridium difficile strains isolated from patients in Ontario, Canada, from 2004 to 2006,” Journal of Clinical Microbiology, vol. 46, no. 9, pp. 2999–3004, 2008. View at Publisher · View at Google Scholar · View at Scopus
  41. H. Martin, L. P. Abbott, D. E. Low, B. Willey, M. Mulvey, and J. S. Weese, “Genotypic investigation of Clostridium difficile in Prince Edward Island,” Canadian Journal of Infectious Diseases and Medical Microbiology, vol. 19, no. 6, pp. 409–412, 2008. View at Google Scholar · View at Scopus
  42. Y. Zhou, C.-A. D. Burnham, T. Hink et al., “Phenotypic and genotypic analysis of clostridium difficile isolates: a single-center study,” Journal of Clinical Microbiology, vol. 52, no. 12, pp. 4260–4266, 2014. View at Publisher · View at Google Scholar · View at Scopus
  43. M. R. Mulvey, D. A. Boyd, D. Gravel et al., “Hypervirulent Clostridium difficile strains in hospitalized patients, Canada,” Emerging Infectious Diseases, vol. 16, no. 4, pp. 678–681, 2010. View at Publisher · View at Google Scholar · View at Scopus
  44. R. A. Stabler, D. N. Gerding, J. G. Songer et al., “Comparative phylogenomics of Clostridium difficile reveals clade specificity and microevolution of hypervirulent strains,” Journal of Bacteriology, vol. 188, no. 20, pp. 7297–7305, 2006. View at Publisher · View at Google Scholar · View at Scopus
  45. M. He, M. Sebaihia, T. D. Lawley et al., “Evolutionary dynamics of Clostridium difficile over short and long time scales,” Proceedings of the National Academy of Sciences of the United States of America, vol. 107, no. 16, pp. 7527–7532, 2010. View at Publisher · View at Google Scholar
  46. A. Goorhuis, D. Bakker, J. Corver et al., “Emergence of Clostridium difficile infection due to a new hypervirulent strain, polymerase chain reaction ribotype 078,” Clinical Infectious Diseases, vol. 47, no. 9, pp. 1162–1170, 2008. View at Publisher · View at Google Scholar · View at Scopus
  47. S. K. Lim, R. L. Stuart, K. E. MacKin et al., “Emergence of a ribotype 244 strain of Clostridium difficile associated with severe disease and related to the epidemic ribotype 027 strain,” Clinical Infectious Diseases, vol. 58, no. 12, pp. 1723–1730, 2014. View at Publisher · View at Google Scholar · View at Scopus
  48. M. N. de Almeida, H. Heffernan, A. Dervan et al., “Severe Clostridium difficile infection in New Zealand associated with an emerging strain, PCR-ribotype 244,” New Zealand Medical Journal, vol. 126, no. 1380, pp. 9–14, 2013. View at Google Scholar · View at Scopus
  49. C. Quesada-Gómez, D. López-Ureña, L. Acuña-Amador et al., “Emergence of an outbreak-associated Clostridium difficile variant with increased virulence,” Journal of Clinical Microbiology, vol. 53, no. 4, pp. 1216–1226, 2015. View at Publisher · View at Google Scholar · View at Scopus
  50. R. Baldan, A. Trovato, V. Bianchini et al., “Clostridium difficile PCR ribotype 018, a successful epidemic genotype,” Journal of Clinical Microbiology, vol. 53, no. 8, pp. 2575–2580, 2015. View at Publisher · View at Google Scholar · View at Scopus
  51. F. C. Lessa, Y. Mu, W. M. Bamberg et al., “Burden of Clostridium difficile infection in the United States,” New England Journal of Medicine, vol. 372, no. 9, pp. 825–834, 2015. View at Publisher · View at Google Scholar · View at Scopus
  52. D. W. Eyre, M. L. Cule, D. J. Wilson et al., “Diverse sources of C. difficile infection identified on whole-genome sequencing,” The New England Journal of Medicine, vol. 369, no. 13, pp. 1195–1205, 2013. View at Publisher · View at Google Scholar · View at Scopus
  53. J. R. Argamany, S. L. Aitken, G. C. Lee, N. K. Boyd, and K. R. Reveles, “Regional and seasonal variation in Clostridium difficile infections among hospitalized patients in the United States, 2001–2010,” American Journal of Infection Control, vol. 43, no. 5, pp. 435–440, 2015. View at Publisher · View at Google Scholar · View at Scopus