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Two Distinct Patterns of Clostridium difficile Diversity Across Europe Indicating Contrasting Routes of Spread

2018-09-14Journal article Open access
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dc.contributor.authorEyre, David W.
dc.contributor.authorDavies, Kerrie A.
dc.contributor.authorDavis, Georgina
dc.contributor.authorFawley, Warren N.
dc.contributor.authorDingle, Kate E.
dc.contributor.authorDe Maio, Nicola
dc.contributor.authorKaras, Andreas
dc.contributor.authorCrook, Derrick W.
dc.contributor.authorPeto, Tim E.A.
dc.contributor.authorWalker, A Sarah
dc.contributor.authorWilcox, Mark H.
dc.contributor.authorEUCLID Study Group
dc.date.accessioned2019-03-21T15:51:41Z
dc.date.available2019-03-21T15:51:41Z
dc.date.issued2018-09-14
dc.descriptionEUCLID study group. European coordinators: INSA - Monica Oleastro (National Institute of Health, Lisbon, Portugal)pt_PT
dc.descriptionFree PMC Article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6137122/pt_PT
dc.descriptionSupplementary Data: Supplementary materials are available at Clinical Infectious Diseases online. Consisting of data provided by the authors to benefit the reader, the posted materials are not copyedited and are the sole responsibility of the authors, so questions or comments should be addressed to the corresponding authorpt_PT
dc.description.abstractBackground: Rates of Clostridium difficile infection vary widely across Europe, as do prevalent ribotypes. The extent of Europe-wide diversity within each ribotype, however, is unknown. Methods: Inpatient diarrheal fecal samples submitted on a single day in summer and winter (2012–2013) to laboratories in 482 European hospitals were cultured for C. difficile, and isolates the 10 most prevalent ribotypes were whole-genome sequenced. Within each ribotype, country-based sequence clustering was assessed using the ratio of the median number of single-nucleotide polymorphisms between isolates within versus across different countries, using permutation tests. Time-scaled Bayesian phylogenies were used to reconstruct the historical location of each lineage. Results: Sequenced isolates (n = 624) were from 19 countries. Five ribotypes had within-country clustering: ribotype 356, only in Italy; ribotype 018, predominantly in Italy; ribotype 176, with distinct Czech and German clades; ribotype 001/072, including distinct German, Slovakian, and Spanish clades; and ribotype 027, with multiple predominantly country-specific clades including in Hungary, Italy, Germany, Romania, and Poland. By contrast, we found no within-country clustering for ribotypes 078, 015, 002, 014, and 020, consistent with a Europe-wide distribution. Fluoroquinolone resistance was significantly more common in within-country clustered ribotypes (P = .009). Fluoroquinolone-resistant isolates were also more tightly clustered geographically with a median (interquartile range) of 43 (0–213) miles between each isolate and the most closely genetically related isolate, versus 421 (204–680) miles in nonresistant pairs (P < .001). Conclusions: Two distinct patterns of C. difficile ribotype spread were observed, consistent with either predominantly healthcare-associated acquisition or Europe-wide dissemination via other routes/sources, for example, the food chain.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationClin Infect Dis. 2018 Sep 14;67(7):1035-1044. doi: 10.1093/cid/ciy252pt_PT
dc.identifier.doi10.1093/cid/ciy252pt_PT
dc.identifier.issn1058-4838
dc.identifier.urihttp://hdl.handle.net/10400.18/6269
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherOxford University Press/ Infectious Diseases Society of Americapt_PT
dc.relation.publisherversionhttps://academic.oup.com/cid/article/67/7/1035/4962508pt_PT
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/pt_PT
dc.subjectClostridium difficilept_PT
dc.subjectRoutes of Spreadpt_PT
dc.subjectTransmissionpt_PT
dc.subjectHealthcarept_PT
dc.subjectCommunitypt_PT
dc.subjectWhole-genome Sequencingpt_PT
dc.subjectInfecções Gastrointestinaispt_PT
dc.titleTwo Distinct Patterns of Clostridium difficile Diversity Across Europe Indicating Contrasting Routes of Spreadpt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage1044pt_PT
oaire.citation.issue7pt_PT
oaire.citation.startPage1035pt_PT
oaire.citation.titleClinical Infectious Diseasespt_PT
oaire.citation.volume67pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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