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dc.contributor.authorHe, Miao
dc.contributor.authorMiyajima, Fabio
dc.contributor.authorRoberts, Paul
dc.contributor.authorEllison, Louise
dc.contributor.authorPickard, Derek J
dc.contributor.authorMartin, Melissa J
dc.contributor.authorConnor, Thomas R
dc.contributor.authorHarris, Simon R
dc.contributor.authorFairley, Derek
dc.contributor.authorBamford, Kathleen B
dc.contributor.authorD'Arc, Stephanie
dc.contributor.authorBrazier, Jon
dc.contributor.authorBrown, Derek
dc.contributor.authorCoia, John E
dc.contributor.authorDouce, Gill
dc.contributor.authorGerding, Dale
dc.contributor.authorKim, Hee Jung
dc.contributor.authorKoh, Tse Hsien
dc.contributor.authorKato, Haru
dc.contributor.authorSenoh, Mitsutoshi
dc.contributor.authorLouie, Tom
dc.contributor.authorMichell, Stephen
dc.contributor.authorButt, Emma
dc.contributor.authorPeacock, Sharon J
dc.contributor.authorBrown, Nick M
dc.contributor.authorRiley, Tom
dc.contributor.authorSonger, Glen
dc.contributor.authorWilcox, Mark
dc.contributor.authorPirmohamed, Munir
dc.contributor.authorKuijper, Ed
dc.contributor.authorHawkey, Peter
dc.contributor.authorWren, Brendan W
dc.contributor.authorDougan, Gordon
dc.contributor.authorParkhill, Julian
dc.contributor.authorLawley, Trevor D
dc.date.accessioned2020-08-19T08:54:04Z
dc.date.available2020-08-19T08:54:04Z
dc.date.issued2012-12-09
dc.identifier.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.2478en
dc.identifier.issn1061-4036en
dc.identifier.doi10.1038/ng.2478en
dc.identifier.urihttp://hdl.handle.net/2436/623500
dc.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.en
dc.description.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.en
dc.description.sponsorshipThis 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.en
dc.formatapplication/pdfen
dc.languageen
dc.language.isoenen
dc.publisherSpringer Science and Business Media LLCen
dc.relation.urlhttps://www.nature.com/articles/ng.2478en
dc.subjectclostridium difficileen
dc.subjectphylogeneticsen
dc.subjectpopulation geneticsen
dc.titleEmergence and global spread of epidemic healthcare-associated Clostridium difficileen
dc.typeJournal articleen
dc.identifier.eissn1546-1718
dc.identifier.journalNature Geneticsen
dc.date.updated2020-08-03T12:39:27Z
dc.date.accepted2012-11-01
rioxxterms.funderWellcome Trust, UK Medical Research Council, Scottish Infection Research Network, NIHRen
rioxxterms.identifier.project098051en
rioxxterms.identifier.project086418en
rioxxterms.identifier.project93614en
rioxxterms.versionAMen
rioxxterms.licenseref.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/en
rioxxterms.licenseref.startdate2020-08-19en
dc.source.volume45
dc.source.issue1
dc.source.beginpage109
dc.source.endpage113
dc.description.versionPublished version
refterms.dateFCD2020-08-19T08:51:30Z
refterms.versionFCDAM
refterms.dateFOA2020-08-19T00:00:00Z


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