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Multicenter Study
. 2019 Jan 7;68(2):204-209.
doi: 10.1093/cid/ciy457.

Clostridium difficile: Investigating Transmission Patterns Between Infected and Colonized Patients Using Whole Genome Sequencing

Ling Yuan Kong  1 , David W Eyre  2   3 , Jacques Corbeil  4 , Frederic Raymond  4 , A Sarah Walker  3 , Mark H Wilcox  5 , Derrick W Crook  2   6 , Sophie Michaud  7 , Baldwin Toye  8 , Eric Frost  7 , Nandini Dendukuri  9 , Ian Schiller  10 , Anne-Marie Bourgault  1   11 , Andrew Dascal  12 , Matthew Oughton  12 , Yves Longtin  12 , Louise Poirier  13 , Paul Brassard  10 , Nathalie Turgeon  14 , Rodica Gilca  15 , Vivian G Loo  1
Affiliations
Multicenter Study

Clostridium difficile: Investigating Transmission Patterns Between Infected and Colonized Patients Using Whole Genome Sequencing

Ling Yuan Kong et al. Clin Infect Dis. .

Abstract

Background: Whole genome sequencing (WGS) studies can enhance our understanding of the role of patients with asymptomatic Clostridium difficile colonization in transmission.

Methods: Isolates obtained from patients with Clostridium difficile infection (CDI) and colonization identified in a study conducted during 2006-2007 at 6 Canadian hospitals underwent typing by pulsed-field gel electrophoresis, multilocus sequence typing, and WGS. Isolates from incident CDI cases not in the initial study were also sequenced where possible. Ward movement and typing data were combined to identify plausible donors for each CDI case, as defined by shared time and space within predefined limits. Proportions of plausible donors for CDI cases that were colonized, infected, or both were examined.

Results: Five hundred fifty-four isolates were sequenced successfully, 353 from colonized patients and 201 from CDI cases. The NAP1/027/ST1 strain was the most common strain, found in 124 (62%) of infected and 92 (26%) of colonized patients. A donor with a plausible ward link was found for 81 CDI cases (40%) using WGS with a threshold of ≤2 single nucleotide polymorphisms to determine relatedness. Sixty-five (32%) CDI cases could be linked to both infected and colonized donors. Exclusive linkages to infected and colonized donors were found for 28 (14%) and 12 (6%) CDI cases, respectively.

Conclusions: Colonized patients contribute to transmission, but CDI cases are more likely linked to other infected patients than colonized patients in this cohort with high rates of the NAP1/027/ST1 strain, highlighting the importance of local prevalence of virulent strains in determining transmission dynamics.

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Figures

Figure 1.
Figure 1.
Flowchart of patients and isolates included in analysis. aInfection control surveillance isolates were available for 1 site. Abbreviation: CDI, Clostridium difficile infection.
Figure 2.
Figure 2.
Multilocus sequence types by infected or colonized status. Polymerase chain reaction ribotypes are shown in parentheses. Abbreviations: CDI, Clostridium difficile infection; ST, sequence type.
See this image and copyright information in PMC

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References

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