Emergence and global spread of epidemic healthcare-associated Clostridium difficile
Authors
He, MiaoMiyajima, Fabio
Roberts, Paul

Ellison, Louise
Pickard, Derek J
Martin, Melissa J
Connor, Thomas R
Harris, Simon R
Fairley, Derek
Bamford, Kathleen B
D'Arc, Stephanie
Brazier, Jon
Brown, Derek
Coia, John E
Douce, Gill
Gerding, Dale
Kim, Hee Jung
Koh, Tse Hsien
Kato, Haru
Senoh, Mitsutoshi
Louie, Tom
Michell, Stephen
Butt, Emma
Peacock, Sharon J
Brown, Nick M
Riley, Tom
Songer, Glen
Wilcox, Mark
Pirmohamed, Munir
Kuijper, Ed
Hawkey, Peter
Wren, Brendan W
Dougan, Gordon
Parkhill, Julian
Lawley, Trevor D
Issue Date
2012-12-09
Metadata
Show full item recordAbstract
Epidemic C. difficile (027/BI/NAP1) has rapidly emerged in the past decade as the leading cause of antibiotic-associated diarrhea worldwide. However, the key events in evolutionary history leading to its emergence and the subsequent patterns of global spread remain unknown. Here, we define the global population structure of C. difficile 027/BI/NAP1 using whole-genome sequencing and phylogenetic analysis. We show that two distinct epidemic lineages, FQR1 and FQR2, not one as previously thought, emerged in North America within a relatively short period after acquiring the same fluoroquinolone resistance–conferring mutation and a highly related conjugative transposon. The two epidemic lineages showed distinct patterns of global spread, and the FQR2 lineage spread more widely, leading to healthcare-associated outbreaks in the UK, continental Europe and Australia. Our analysis identifies key genetic changes linked to the rapid transcontinental dissemination of epidemic C. difficile 027/BI/NAP1 and highlights the routes by which it spreads through the global healthcare system.Citation
He, M., Miyajima, F., Roberts, P., Ellison, L. et al. (2013) Emergence and global spread of epidemic healthcare-associated Clostridium difficile, Nature Genetics, 45, pp. 109–113. https://doi.org/10.1038/ng.2478Publisher
Springer Science and Business Media LLCJournal
Nature GeneticsDOI
10.1038/ng.2478Additional Links
https://www.nature.com/articles/ng.2478Type
Journal articleLanguage
enDescription
This is an accepted manuscript of an article published by Nature in Nature Genetics on 09/12/2012, available online: https://doi.org/10.1038/ng.2478 The accepted version of the publication may differ from the final published version.ISSN
1061-4036EISSN
1546-1718Sponsors
This project was funded by the Wellcome Trust (grant numbers 098051 and 086418), the Medical Research Council New Investigator Research Grant (TDL; grant number 93614) and the Scottish Infection Research Network. We acknowledge the funding from the NIHR Biomedical Research Centre in Liverpool. Both FM and PR were supported by the BRC. MP is a NIHR Senior Investigator.ae974a485f413a2113503eed53cd6c53
10.1038/ng.2478
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Except where otherwise noted, this item's license is described as https://creativecommons.org/licenses/by-nc-nd/4.0/