Emergence and global spread of epidemic healthcare-associated Clostridium difficile
Pickard, Derek J
Martin, Melissa J
Connor, Thomas R
Harris, Simon R
Bamford, Kathleen B
Coia, John E
Kim, Hee Jung
Koh, Tse Hsien
Peacock, Sharon J
Brown, Nick M
Wren, Brendan W
Lawley, Trevor D
MetadataShow full item record
AbstractEpidemic 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.
CitationHe, 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.2478
PublisherSpringer Science and Business Media LLC
DescriptionThis 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.
SponsorsThis 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.
Except where otherwise noted, this item's license is described as https://creativecommons.org/licenses/by-nc-nd/4.0/