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Emergence and global spread of epidemic healthcare-associated Clostridium difficile

He, Miao
; 
Miyajima, Fabio
; ; 
Ellison, Louise
; 
Pickard, Derek J
; 
Martin, Melissa J
; 
Connor, Thomas R
; 
Harris, Simon R
; 
Fairley, Derek
; 
Bamford, Kathleen B
... show 10 more
Authors
He, Miao
 Miyajima, 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
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Affiliation
Epub Date
Issue Date
2012-12-09
Submitted date
Subjects
clostridium difficile
 phylogenetics
 population genetics
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Abstract
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.2478
Publisher
Springer Science and Business Media LLC
Journal
Nature Genetics
Research Unit
URI
http://hdl.handle.net/2436/623500
DOI
10.1038/ng.2478
PubMed ID
PubMed Central ID
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Additional Links
https://www.nature.com/articles/ng.2478
Type
Journal article
Language
en
Description
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.
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ISSN
1061-4036
EISSN
1546-1718
ISBN
ISMN
Gov't Doc #
Sponsors
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.
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