The recent emergence of a highly related virulent <i>Clostridium difficile</i> clade with unique characteristics

Shaw, HA, Preston, MD, Vendrik, KEW, Cairns, MD, Browne, HP, Stabler, RA, Crobach, MJT, Corver, J, Pituch, H, Ingebretsen, A
et al (show 7 more authors) (2020) The recent emergence of a highly related virulent <i>Clostridium difficile</i> clade with unique characteristics. CLINICAL MICROBIOLOGY AND INFECTION, 26 (4). pp. 492-498.

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Shaw HA, Preston MD, Vendrik KEW, Cairns MD, Browne HP, Stabler RA, Crobach MJT, Corver J, Pituch H, Ingebretsen A, Pirmohamed M, Faulds-Pain A, Valiente E, Lawley TD, Fairweather NF, Kuijper EJ, Wren BW.pdf - Published version

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<h4>Objectives</h4>Clostridium difficile is a major global human pathogen divided into five clades, of which clade 3 is the least characterized and consists predominantly of PCR ribotype (RT) 023 strains. Our aim was to analyse and characterize this clade.<h4>Methods</h4>In this cohort study the clinical presentation of C. difficile RT023 infections was analysed in comparison with known 'hypervirulent' and non-hypervirulent strains, using data from the Netherlands national C. difficile surveillance programme. European RT023 strains of diverse origin were collected and whole-genome sequenced to determine the genetic similarity between isolates. Distinctive features were investigated and characterized.<h4>Results</h4>Clinical presentation of C. difficile RT023 infections show severe infections akin to those seen with 'hypervirulent' strains from clades 2 (RT027) and 5 (RT078) (35%, 29% and 27% severe CDI, respectively), particularly with significantly more bloody diarrhoea than RT078 and non-hypervirulent strains (RT023 8%, other RTs 4%, p 0.036). The full genome sequence of strain CD305 is presented as a robust reference. Phylogenetic comparison of CD305 and a further 79 previously uncharacterized European RT023 strains of diverse origin revealed minor genetic divergence with >99.8% pairwise identity between strains. Analyses revealed distinctive features among clade 3 strains, including conserved pathogenicity locus, binary toxin and phage insertion toxin genotypes, glycosylation of S-layer proteins, presence of the RT078 four-gene trehalose cluster and an esculinase-negative genotype.<h4>Conclusions</h4>Given their recent emergence, virulence and genomic characteristics, the surveillance of clade 3 strains should be more highly prioritized.

Item Type: Article
Uncontrolled Keywords: Clostridium difficile, Clostridium difficile infection, Next-generation sequencing, RT023, Trehalose, S-layer, Clade 3
Depositing User: Symplectic Admin
Date Deposited: 31 Oct 2019 11:40
Last Modified: 14 Oct 2023 09:42
DOI: 10.1016/j.cmi.2019.09.004
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