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. 2020 Oct 21;58(11):e01552-20.
doi: 10.1128/JCM.01552-20. Print 2020 Oct 21.

Laboratory-Based Surveillance of Clostridium difficile Infection in Australian Health Care and Community Settings, 2013 to 2018

Stacey Hong  1   2 , Papanin Putsathit  3 , Narelle George  4 , Christine Hemphill  5 , Peter G Huntington  6 , Tony M Korman  7 , Despina Kotsanas  7 , Monica Lahra  8 , Rodney McDougall  9 , Casey V Moore  10 , Graeme R Nimmo  4 , Louise Prendergast  5 , Jennifer Robson  9 , Lynette Waring  5 , Michael C Wehrhahn  11 , Gerhard F Weldhagen  10 , Richard M Wilson  12 , Thomas V Riley  13   2   3   14 , Daniel R Knight  2
Affiliations

Laboratory-Based Surveillance of Clostridium difficile Infection in Australian Health Care and Community Settings, 2013 to 2018

Stacey Hong et al. J Clin Microbiol. .

Abstract

In the early 2000s, a binary toxin (CDT)-producing strain of Clostridium difficile, ribotype 027 (RT027), caused extensive outbreaks of diarrheal disease in North America and Europe. This strain has not become established in Australia, and there is a markedly different repertoire of circulating strains there compared to other regions of the world. The C. difficile Antimicrobial Resistance Surveillance (CDARS) study is a nationwide longitudinal surveillance study of C. difficile infection (CDI) in Australia. Here, we describe the molecular epidemiology of CDI in Australian health care and community settings over the first 5 years of the study, 2013 to 2018. Between 2013 and 2018, 10 diagnostic microbiology laboratories from five states in Australia participated in the CDARS study. From each of five states, one private (representing community) and one public (representing hospitals) laboratory submitted isolates of C. difficile or PCR-positive stool samples during two collection periods per year, February-March (summer/autumn) and August-September (winter/spring). C. difficile was characterized by toxin gene profiling and ribotyping. A total of 1,523 isolates of C. difficile were studied. PCR ribotyping yielded 203 different RTs, the most prevalent being RT014/020 (n = 449; 29.5%). The epidemic CDT+ RT027 (n = 2) and RT078 (n = 6), and the recently described RT251 (n = 10) and RT244 (n = 6) were not common, while RT126 (n = 17) was the most prevalent CDT+ type. A heterogeneous C. difficile population was identified. C. difficile RT014/020 was the most prevalent type found in humans with CDI. Continued surveillance of CDI in Australia remains critical for the detection of emerging strain lineages.

Keywords: Clostridium difficile; molecular epidemiology; ribotyping; surveillance.

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Figures

FIG 1
FIG 1
Dendrogram summary, toxin profiles, and distributions of the 20 most prevalent C. difficile PCR RTs. PCR ribotyping pattern cluster analysis using both the Dice coefficient and the neighbor-joining method was used. Proportions were compared by χ2 test. *, P < 0.05. NSW, New South Wales; QLD, Queensland; SA, South Australia; VIC, Victoria; WA, Western Australia.
FIG 2
FIG 2
Molecular epidemiology of CDI in Australia. Distribution of C. difficile RTs by Australian state (A) and by private or public collection site (B) over 10 collection phases, 2013 to 2018 (n = 1,523). NSW, New South Wales; QLD, Queensland; SA, South Australia; VIC, Victoria; WA, Western Australia. (The map was created with mapchart.net and is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License [https://creativecommons.org/licenses/by-sa/4.0/].)
FIG 3
FIG 3
Seasonal distribution for the top 12 most prevalent RTs in Australia, 2013 to 2018.
See this image and copyright information in PMC

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