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Genomic evolution and re-emergence of a multidrug-resistant Clostridioides difficile RT027 clone with reduced vancomycin susceptibility driving a prolonged hospital outbreak

2026-03-17Artigo científico Acesso aberto
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datacite.subject.fosCiências Médicas
datacite.subject.sdg03:Saúde de Qualidade
dc.contributor.authorIsidro, Joana
dc.contributor.authorDionísio, Filipa
dc.contributor.authorAlves, Frederico
dc.contributor.authorAlmeida, Soraia
dc.contributor.authorSantos, Cláudia
dc.contributor.authorSantos, Manuel Mota
dc.contributor.authorReis, Ernestina
dc.contributor.authorOliveira, Júlio R.
dc.contributor.authorGomes, João Paulo
dc.contributor.authorOleastro, Mónica
dc.date.accessioned2026-09-28T14:10:53Z
dc.date.available2026-09-28T14:10:53Z
dc.date.issued2026-03-17
dc.description.abstractFollowing an extended period of declining prevalence of the epidemic Clostridioides difficile ribotype 027 (RT027) in Portugal, a genetically distinct, multidrug-resistant (MDR) RT027 strain with reduced susceptibility to vancomycin has emerged, causing a 15-month outbreak. This investigation provides epidemiological and genomic evidence for renewed circulation and evolutionary adaptation of this high-risk lineage. A comprehensive outbreak investigation was conducted in a tertiary-care hospital in northern Portugal between 2023 and 2025. Epidemiological and clinical data, antimicrobial exposures, and infection-control measures were analysed. Whole-genome sequencing (WGS) was performed to characterize the outbreak clone. Sixty-six RT027 C. difficile infection (CDI) cases were confirmed, with incidence peaking at 5.46 cases per 10,000 patient-bed days in April 2024. WGS revealed an unusual accumulation of AMR determinants conferring a broad MDR phenotype. Notably, all isolates harboured the VanR T115A substitution, a rare mutation previously linked to reduced vancomycin susceptibility, raising concerns regarding evolving antimicrobial tolerance within RT027. The close relatedness to 2016-2018 USA isolates suggests a recent emergence of this clone. Transmission was facilitated by structural constraints, limited isolation capacity and shared sanitary facilities. This prolonged outbreak documents the re-emergence and genomic evolution of a hypervirulent RT027 lineage, characterized by a concerning expansion of antimicrobial resistance and decreased vancomycin susceptibility and a high recurrence rate (25%). These findings highlight the ongoing adaptive potential of C. difficile under antimicrobial pressure and underscore the need for strengthened surveillance, genomic monitoring, and infection-prevention strategies to mitigate re-establishment of epidemic RT027 strains in Europe and beyond.eng
dc.description.sponsorshipThis study was co-funded by the project GENEO “Sustain-able use and integration of enhanced infrastructure intoroutine genome-based surveillance and outbreak investi-gation activities in Portugal” (Project no. 101113460) onbehalf of the EU4H programme (EU4H-2022-DGA-MS-IBA-01-02), and by the project CENTAUR “Creating andrefining whole-genome and core-genome typing schemasfor pathogen surveillance”, funded by the European Com-mission through the ISIDORe JRA initiative (reference 101046133). FD is the recipient of a research fellowship(2017DDI1446) from INSA, and FA is the recipient of aPhD fellowship from Fundação para a Ciência e Tecnologia(2024.02920.BDANA).
dc.identifier.citationEmerg Microbes Infect. 2026 Dec;15(1):2640707. doi: 10.1080/22221751.2026.2640707
dc.identifier.doi10.1080/22221751.2026.2640707
dc.identifier.eissn2222-1751
dc.identifier.pmid41774571
dc.identifier.urihttp://hdl.handle.net/10400.18/11343
dc.language.isoeng
dc.peerreviewedyes
dc.publisherTaylor and Francis Group
dc.relation101113460
dc.relation101046133
dc.relation2017DDI1446
dc.relation2024.02920.BDANA
dc.relation.hasversionhttps://www.tandfonline.com/doi/full/10.1080/22221751.2026.2640707
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subjectClostridioides difficile hypervirulent RT027 re-emergence
dc.subjectVancomycin resistance VanR T115A mutation
dc.subjectGenomic Surveillance
dc.subjectHealthcare-Associated Outbreak
dc.subjectmultidrug-resistance
dc.subjectMultidrug-Resistance
dc.subjectInfecções Gastrointestinais
dc.subjectResistência aos Antimicrobianos
dc.titleGenomic evolution and re-emergence of a multidrug-resistant Clostridioides difficile RT027 clone with reduced vancomycin susceptibility driving a prolonged hospital outbreakeng
dc.typejournal article
dspace.entity.typePublication
oaire.citation.issue1
oaire.citation.startPage2640707
oaire.citation.titleEmerging Microbes & Infections
oaire.citation.volume15
oaire.versionhttp://purl.org/coar/version/c_970fb48d4fbd8a85

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