Laboratory-Based Surveillance of Clostridium difficile Infection in Australian Health Care and Community Settings, 2013 to 2018

Stacey Hong, Papanin Putsathit, Narelle George, Christine Hemphill, Peter G. Huntington, Tony M. Korman, Despina Kotsanas, Monica Lahra, Rodney McDougall, Casey V. Moore, Graeme R. Nimmo, Louise Prendergast, Jennifer Robson, Lynette Waring, Michael C. Wehrhahn, Gerhard F. Weldhagen, Richard M. Wilson, Thomas V. Riley, Daniel R. Knight

Research output: Contribution to journalArticleResearchpeer-review

17 Citations (Scopus)


In the early 2000s, a binary toxin (CDT)-producing strain of Clostridium difficile, ribotype 027 (RT027), caused extensive outbreaks of diarrheal disease in North America and Europe. This strain has not become established in Australia, and there is a markedly different repertoire of circulating strains there compared to other regions of the world. The C. difficile Antimicrobial Resistance Surveillance (CDARS) study is a nationwide longitudinal surveillance study of C. difficile infection (CDI) in Australia. Here, we describe the molecular epidemiology of CDI in Australian health care and community settings over the first 5 years of the study, 2013 to 2018. Between 2013 and 2018, 10 diagnostic microbiology laboratories from five states in Australia participated in the CDARS study. From each of five states, one private (representing community) and one public (representing hospitals) laboratory submitted isolates of C. difficile or PCR-positive stool samples during two collection periods per year, February-March (summer/autumn) and August-September (winter/spring). C. difficile was characterized by toxin gene profiling and ribotyping. A total of 1,523 isolates of C. difficile were studied. PCR ribotyping yielded 203 different RTs, the most prevalent being RT014/020 (n = 449; 29.5%). The epidemic CDT+ RT027 (n = 2) and RT078 (n = 6), and the recently described RT251 (n = 10) and RT244 (n = 6) were not common, while RT126 (n = 17) was the most prevalent CDT+ type. A heterogeneous C. difficile population was identified. C. difficile RT014/020 was the most prevalent type found in humans with CDI. Continued surveillance of CDI in Australia remains critical for the detection of emerging strain lineages.

Original languageEnglish
Article numbere01552-20
Number of pages9
JournalJournal of Clinical Microbiology
Issue number11
Publication statusPublished - Oct 2020


  • Clostridium difficile
  • molecular epidemiology
  • ribotyping
  • surveillance

Cite this