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Clostridium difficile healthcare-associated epidemics

Nature Genetics volume 45, pages 6–7 (2013)Cite this article

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A new study reports whole-genome sequencing of a large collection of healthcare-associated C. difficile isolates, followed by comparative genomics and phylogenetic analyses. This work provides insight into the emergence of the current C. difficile epidemic 027/BI/NAP1 clone, which can be separated into two lineages on the basis of both SNPs and larger genetic changes mediated by mobile elements.

C. difficile, a Gram-positive spore-forming bacterium, has emerged as the most common cause of infectious antibiotic-associated diarrhea and healthcare-associated infection in the developed world1,2. The major risk factors for C. difficile colonization are hospitalization and treatment with antibiotics3, and disease can include a range of clinical presentations from asymptomatic carriage to diarrhea, pseudomembranous colitis or, in the most severe cases, death3. C. difficile also produces infectious spores that are highly resistant to the cleaning procedures employed in healthcare settings, thereby facilitating both local transmission within a healthcare facility4 and global distribution5. Over the last two decades, C. difficile infection rates have significantly increased, along with rates of disease, recurrence and mortality6,7. Many of these epidemiological changes can be linked to the emergence of a specific hypervirulent clone, C. difficile 027/BI/NAP1. On page 109 of this issue, Trevor Lawley and colleagues8 report the whole-genome sequencing of a large global collection of healthcare-associated C. difficile strains from current epidemics, providing insight into the origins and spread of this dominant and hypervirulent C. difficile clone.

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Figure 1: Global expansion of C. difficile 027/BI/NAP1 lineages.

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  1. Department of Microbiology and Immunology, David A. Rasko is at the Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA.,

    David A Rasko

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Correspondence to David A Rasko.

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Rasko, D. Clostridium difficile healthcare-associated epidemics. Nat Genet 45, 6–7 (2013). https://doi.org/10.1038/ng.2499

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