Emergence and spread of predominantly community-onset Clostridium difficile PCR ribotype 244 infection in Australia, 2010 to 2012

David W Eyre, Lauren E Tracey, Briony Elliott, Claudia Slimings, Peter G Huntington, Rhonda L Stuart, Tony M Korman, George Kotsiou, Rebecca McCann, David Griffiths, Warren N Fawley, Paul K Armstrong, Kate E Dingle, Sarah Ann Walker, Timothy Edward Alexander Peto, Derrick W Crook, Mark H Wilcox, Thomas Victor Riley

Research output: Contribution to journalArticleResearchpeer-review

Abstract

We describe an Australia-wide Clostridium difficile outbreak in 2011 and 2012 involving the previously uncommon ribotype 244. In Western Australia, 14 of 25 cases were community-associated, 11 were detected in patients younger than?65 years, 14 presented to emergency/outpatient departments, and 14 to non-tertiary/community hospitals. Using whole genome sequencing, we confirm ribotype 244 is from the same C. difficile clade as the epidemic ribotype 027. Like ribotype 027, it produces toxins A, B, and binary toxin, however it is fluoroquinolone-susceptible and thousands of single nucleotide variants distinct from ribotype 027. Fifteen outbreak isolates from across Australia were sequenced. Despite their geographic separation, all were genetically highly related without evidence of geographic clustering, consistent with a point source, for example affecting the national food chain. Comparison with reference laboratory strains revealed the outbreak clone shared a common ancestor with isolates from the United States and United Kingdom (UK). A strain obtained in the UK was phylogenetically related to our outbreak. Follow-up of that case revealed the patient had recently returned from Australia. Our data demonstrate new C. difficile strains are an on-going threat, with potential for rapid spread. Active surveillance is needed to identify and control emerging lineages.
Original languageEnglish
Article number4
Number of pages10
JournalEurosurveillance
Volume20
Issue number10
DOIs
Publication statusPublished - 12 Mar 2015

Cite this

Eyre, David W ; Tracey, Lauren E ; Elliott, Briony ; Slimings, Claudia ; Huntington, Peter G ; Stuart, Rhonda L ; Korman, Tony M ; Kotsiou, George ; McCann, Rebecca ; Griffiths, David ; Fawley, Warren N ; Armstrong, Paul K ; Dingle, Kate E ; Walker, Sarah Ann ; Peto, Timothy Edward Alexander ; Crook, Derrick W ; Wilcox, Mark H ; Riley, Thomas Victor. / Emergence and spread of predominantly community-onset Clostridium difficile PCR ribotype 244 infection in Australia, 2010 to 2012. In: Eurosurveillance. 2015 ; Vol. 20, No. 10.
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title = "Emergence and spread of predominantly community-onset Clostridium difficile PCR ribotype 244 infection in Australia, 2010 to 2012",
abstract = "We describe an Australia-wide Clostridium difficile outbreak in 2011 and 2012 involving the previously uncommon ribotype 244. In Western Australia, 14 of 25 cases were community-associated, 11 were detected in patients younger than?65 years, 14 presented to emergency/outpatient departments, and 14 to non-tertiary/community hospitals. Using whole genome sequencing, we confirm ribotype 244 is from the same C. difficile clade as the epidemic ribotype 027. Like ribotype 027, it produces toxins A, B, and binary toxin, however it is fluoroquinolone-susceptible and thousands of single nucleotide variants distinct from ribotype 027. Fifteen outbreak isolates from across Australia were sequenced. Despite their geographic separation, all were genetically highly related without evidence of geographic clustering, consistent with a point source, for example affecting the national food chain. Comparison with reference laboratory strains revealed the outbreak clone shared a common ancestor with isolates from the United States and United Kingdom (UK). A strain obtained in the UK was phylogenetically related to our outbreak. Follow-up of that case revealed the patient had recently returned from Australia. Our data demonstrate new C. difficile strains are an on-going threat, with potential for rapid spread. Active surveillance is needed to identify and control emerging lineages.",
author = "Eyre, {David W} and Tracey, {Lauren E} and Briony Elliott and Claudia Slimings and Huntington, {Peter G} and Stuart, {Rhonda L} and Korman, {Tony M} and George Kotsiou and Rebecca McCann and David Griffiths and Fawley, {Warren N} and Armstrong, {Paul K} and Dingle, {Kate E} and Walker, {Sarah Ann} and Peto, {Timothy Edward Alexander} and Crook, {Derrick W} and Wilcox, {Mark H} and Riley, {Thomas Victor}",
year = "2015",
month = "3",
day = "12",
doi = "10.2807/1560-7917.ES2015.20.10.21059",
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Eyre, DW, Tracey, LE, Elliott, B, Slimings, C, Huntington, PG, Stuart, RL, Korman, TM, Kotsiou, G, McCann, R, Griffiths, D, Fawley, WN, Armstrong, PK, Dingle, KE, Walker, SA, Peto, TEA, Crook, DW, Wilcox, MH & Riley, TV 2015, 'Emergence and spread of predominantly community-onset Clostridium difficile PCR ribotype 244 infection in Australia, 2010 to 2012' Eurosurveillance, vol. 20, no. 10, 4. https://doi.org/10.2807/1560-7917.ES2015.20.10.21059

Emergence and spread of predominantly community-onset Clostridium difficile PCR ribotype 244 infection in Australia, 2010 to 2012. / Eyre, David W; Tracey, Lauren E; Elliott, Briony; Slimings, Claudia; Huntington, Peter G; Stuart, Rhonda L; Korman, Tony M; Kotsiou, George; McCann, Rebecca; Griffiths, David; Fawley, Warren N; Armstrong, Paul K; Dingle, Kate E; Walker, Sarah Ann; Peto, Timothy Edward Alexander; Crook, Derrick W; Wilcox, Mark H; Riley, Thomas Victor.

In: Eurosurveillance, Vol. 20, No. 10, 4, 12.03.2015.

Research output: Contribution to journalArticleResearchpeer-review

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