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We describe an Australia-wide Clostridium difficile outbreak in 2011 and 2012 involving the previously uncommon ribotype 244. In Western Australia, 14 of 25 cases were community-associated, 11 were detected in patients younger than 65 years, 14 presented to emergency/outpatient departments, and 14 to non-tertiary/community hospitals. Using whole genome sequencing, we confirm ribotype 244 is from the same C. difficile clade as the epidemic ribotype 027. Like ribotype 027, it produces toxins A, B, and binary toxin, however it is fluoroquinolone-susceptible and thousands of single nucleotide variants distinct from ribotype 027. Fifteen outbreak isolates from across Australia were sequenced. Despite their geographic separation, all were genetically highly related without evidence of geographic clustering, consistent with a point source, for example affecting the national food chain. Comparison with reference laboratory strains revealed the outbreak clone shared a common ancestor with isolates from the United States and United Kingdom (UK). A strain obtained in the UK was phylogenetically related to our outbreak. Follow-up of that case revealed the patient had recently returned from Australia. Our data demonstrate new C. difficile strains are an on-going threat, with potential for rapid spread. Active surveillance is needed to identify and control emerging lineages.

Type

Journal article

Journal

Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin

Publication Date

12/03/2015

Volume

20

Addresses

Nuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom.

Keywords

Humans, Clostridium difficile, Enterocolitis, Pseudomembranous, Communicable Diseases, Emerging, Bacterial Proteins, Bacterial Toxins, Ribotyping, Severity of Illness Index, Population Surveillance, Prevalence, Disease Outbreaks, Phylogeny, Polymorphism, Single Nucleotide, Genome, Bacterial, Adult, Aged, Aged, 80 and over, Middle Aged, Western Australia, Male