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Bacteriology

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

Stacey Hong, Papanin Putsathit, Narelle George, Christine Hemphill, Peter G. Huntington, Tony M. Korman, Despina Kotsanas, Monica Lahra, Rodney McDougall, Casey V. Moore, Graeme R. Nimmo, Louise Prendergast, Jennifer Robson, Lynette Waring, Michael C. Wehrhahn, Gerhard F. Weldhagen, Richard M. Wilson, Thomas V. Riley, Daniel R. Knight
Daniel J. Diekema, Editor
Stacey Hong
aSchool of Biomedical Sciences, Faculty of Health and Medical Sciences, The University of Western Australia, Queen Elizabeth II Medical Centre, Nedlands, WA, Australia
bMedical, Molecular and Forensic Sciences, Murdoch University, Murdoch, WA, Australia
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Papanin Putsathit
cSchool of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
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Narelle George
dPathology Queensland, Royal Brisbane and Women’s Hospital, Herston, QLD, Australia
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Christine Hemphill
eMelbourne Pathology, Collingwood, VIC, Australia
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Peter G. Huntington
fDepartment of Microbiology, NSW Health Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia
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Tony M. Korman
gMonash Infectious Diseases, Monash University and Monash Health, Monash Medical Centre, Clayton, VIC, Australia
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Despina Kotsanas
gMonash Infectious Diseases, Monash University and Monash Health, Monash Medical Centre, Clayton, VIC, Australia
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Monica Lahra
hDepartment of Microbiology, The Prince of Wales Hospital, Randwick, NSW, Australia
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Rodney McDougall
iSullivan Nicolaides Pathology, Taringa, QLD, Australia
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Casey V. Moore
jMicrobiology and Infectious Diseases Laboratories, SA Pathology, Adelaide, SA, Australia
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Graeme R. Nimmo
dPathology Queensland, Royal Brisbane and Women’s Hospital, Herston, QLD, Australia
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Louise Prendergast
eMelbourne Pathology, Collingwood, VIC, Australia
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Jennifer Robson
iSullivan Nicolaides Pathology, Taringa, QLD, Australia
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Lynette Waring
eMelbourne Pathology, Collingwood, VIC, Australia
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Michael C. Wehrhahn
kDouglass Hanly Moir Pathology, Macquarie Park, NSW, Australia
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Gerhard F. Weldhagen
jMicrobiology and Infectious Diseases Laboratories, SA Pathology, Adelaide, SA, Australia
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Richard M. Wilson
lAustralian Clinical Labs, Microbiology Department, Wayville, SA, Australia
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Thomas V. Riley
aSchool of Biomedical Sciences, Faculty of Health and Medical Sciences, The University of Western Australia, Queen Elizabeth II Medical Centre, Nedlands, WA, Australia
bMedical, Molecular and Forensic Sciences, Murdoch University, Murdoch, WA, Australia
cSchool of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
mDepartment of Microbiology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, WA, Australia
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Daniel R. Knight
bMedical, Molecular and Forensic Sciences, Murdoch University, Murdoch, WA, Australia
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Daniel J. Diekema
University of Iowa College of Medicine
Roles: Editor
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DOI: 10.1128/JCM.01552-20
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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.

FOOTNOTES

    • Received 22 June 2020.
    • Returned for modification 28 July 2020.
    • Accepted 22 August 2020.
    • Accepted manuscript posted online 26 August 2020.
  • Supplemental material is available online only.

  • Copyright © 2020 American Society for Microbiology.

All Rights Reserved.

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Laboratory-Based Surveillance of Clostridium difficile Infection in Australian Health Care and Community Settings, 2013 to 2018
Stacey Hong, Papanin Putsathit, Narelle George, Christine Hemphill, Peter G. Huntington, Tony M. Korman, Despina Kotsanas, Monica Lahra, Rodney McDougall, Casey V. Moore, Graeme R. Nimmo, Louise Prendergast, Jennifer Robson, Lynette Waring, Michael C. Wehrhahn, Gerhard F. Weldhagen, Richard M. Wilson, Thomas V. Riley, Daniel R. Knight
Journal of Clinical Microbiology Oct 2020, 58 (11) e01552-20; DOI: 10.1128/JCM.01552-20

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Laboratory-Based Surveillance of Clostridium difficile Infection in Australian Health Care and Community Settings, 2013 to 2018
Stacey Hong, Papanin Putsathit, Narelle George, Christine Hemphill, Peter G. Huntington, Tony M. Korman, Despina Kotsanas, Monica Lahra, Rodney McDougall, Casey V. Moore, Graeme R. Nimmo, Louise Prendergast, Jennifer Robson, Lynette Waring, Michael C. Wehrhahn, Gerhard F. Weldhagen, Richard M. Wilson, Thomas V. Riley, Daniel R. Knight
Journal of Clinical Microbiology Oct 2020, 58 (11) e01552-20; DOI: 10.1128/JCM.01552-20
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KEYWORDS

Clostridium difficile
molecular epidemiology
ribotyping
surveillance

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