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Journal article
Genomic epidemiology and transmission dynamics of recurrent Clostridioides difficile infection in Western Australia
European journal of clinical microbiology & infectious diseases, Vol.42(5), pp.607-619
2023
PMID: 36940050
Abstract
Recurrent cases of Clostridioides difficile infection (rCDI) remain one of the most common and serious challenges faced in the management of CDI. The accurate distinction between a relapse (caused by infection with the same strain) and reinfection (caused by a new strain) has implications for infection control and prevention, and patient therapy. Here, we used whole-genome sequencing to investigate the epidemiology of 94 C. difficile isolates from 38 patients with rCDI in Western Australia. The C. difficile strain population comprised 13 sequence types (STs) led by ST2 (PCR ribotype (RT) 014, 36.2%), ST8 (RT002, 19.1%) and ST34 (RT056, 11.7%). Among 38 patients, core genome SNP (cgSNP) typing found 27 strains (71%) from initial and recurring cases differed by ≤ 2 cgSNPs, suggesting a likely relapse of infection with the initial strain, while eight strains differed by ≥ 3 cgSNPs, suggesting reinfection. Almost half of patients with CDI relapse confirmed by WGS suffered episodes that occurred outside the widely used 8-week cut-off for defining rCDI. Several putative strain transmission events between epidemiologically unrelated patients were identified. Isolates of STs 2 and 34 from rCDI cases and environmental sources shared a recent evolutionary history, suggesting a possible common community reservoir. For some rCDI episodes caused by STs 2 and 231, within-host strain diversity was observed, characterised by loss/gain of moxifloxacin resistance. Genomics improves discrimination of relapse from reinfection and identifies putative strain transmission events among patients with rCDI. Current definitions of relapse and reinfection based on the timing of recurrence need to be reconsidered.
Details
- Title
- Genomic epidemiology and transmission dynamics of recurrent Clostridioides difficile infection in Western Australia
- Authors/Creators
- Daniel R Knight - Department of Microbiology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, Western Australia, Australia. daniel.knight@uwa.edu.auKorakrit Imwattana - Mahidol UniversityDeirdre A Collins - Edith Cowan UniversitySu-Chen Lim - School of Biomedical Sciences, The University of Western Australia, Nedlands, Western Australia, AustraliaStacey Hong - Queen Elizabeth II Medical CentrePapanin Putsathit - School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, AustraliaThomas V Riley - Murdoch University, Centre for Biosecurity and One Health
- Publication Details
- European journal of clinical microbiology & infectious diseases, Vol.42(5), pp.607-619
- Publisher
- Springer
- Grant note
- GNT1156789 / National Health and Medical Research Council GNT1138257 / National Health and Medical Research Council
- Identifiers
- 991005572568807891
- Copyright
- © 2023 The Author(s)
- Murdoch Affiliation
- Harry Butler Institute
- Language
- English
- Resource Type
- Journal article
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- 1 Clinical & Life Sciences
- 1.120 Inflammatory Bowel Diseases & Infections
- 1.120.1133 Clostridium Infections
- Web Of Science research areas
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- Microbiology
- ESI research areas
- Microbiology