TY - JOUR
T1 - Clostridioides difficile Whole-genome Sequencing Differentiates Relapse with the Same Strain from Reinfection with a New Strain
AU - Cho, Janice
AU - Cunningham, Scott
AU - Pu, Meng
AU - Lennon, Ryan J.
AU - Dens Higano, Jennifer
AU - Jeraldo, Patricio
AU - Sampathkumar, Priya
AU - Shannon, Samantha
AU - Kashyap, Purna C.
AU - Patel, Robin
N1 - Publisher Copyright:
© 2020 The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.
PY - 2021/3/1
Y1 - 2021/3/1
N2 - Background: Current approaches in tracking Clostridioides difficile infection (CDI) and individualizing patient management are incompletely defined. Methods: We recruited 468 subjects with CDI at Mayo Clinic Rochester between May and December 2016 and performed whole-genome sequencing (WGS) on C. difficile isolates from 397. WGS was also performed on isolates from a subset of the subjects at the time of a recurrence of infection. The sequence data were analyzed by determining core genome multilocus sequence type (cgMLST), with isolates grouped by allelic differences and the predicted ribotype. Results: There were no correlations between C. difficile isolates based either on cgMLST or ribotype groupings and CDI outcome. An epidemiologic assessment of hospitalized subjects harboring C. difficile isolates with ≤2 allelic differences, based on standard infection prevention and control assessment, revealed no evidence of person-to-person transmission. Interestingly, community-acquired CDI subjects in 40% of groups with ≤2 allelic differences resided within the same zip code. Among 18 subjects clinically classified as having recurrent CDI, WGS revealed 14 with initial and subsequent isolates differing by ≤2 allelic differences, suggesting a relapse of infection with the same initial strain, and 4 with isolates differing by >50 allelic differences, suggesting reinfection. Among the 5 subjects classified as having a reinfection based on the timing of recurrence, 3 had isolates with ≤2 allelic differences between them, suggesting a relapse, and 2 had isolates differing by >50 allelic differences, suggesting reinfection. Conclusions: Our findings point to potential transmission of C. difficile in the community. WGS better differentiates relapse from reinfection than do definitions based on the timing of recurrence.
AB - Background: Current approaches in tracking Clostridioides difficile infection (CDI) and individualizing patient management are incompletely defined. Methods: We recruited 468 subjects with CDI at Mayo Clinic Rochester between May and December 2016 and performed whole-genome sequencing (WGS) on C. difficile isolates from 397. WGS was also performed on isolates from a subset of the subjects at the time of a recurrence of infection. The sequence data were analyzed by determining core genome multilocus sequence type (cgMLST), with isolates grouped by allelic differences and the predicted ribotype. Results: There were no correlations between C. difficile isolates based either on cgMLST or ribotype groupings and CDI outcome. An epidemiologic assessment of hospitalized subjects harboring C. difficile isolates with ≤2 allelic differences, based on standard infection prevention and control assessment, revealed no evidence of person-to-person transmission. Interestingly, community-acquired CDI subjects in 40% of groups with ≤2 allelic differences resided within the same zip code. Among 18 subjects clinically classified as having recurrent CDI, WGS revealed 14 with initial and subsequent isolates differing by ≤2 allelic differences, suggesting a relapse of infection with the same initial strain, and 4 with isolates differing by >50 allelic differences, suggesting reinfection. Among the 5 subjects classified as having a reinfection based on the timing of recurrence, 3 had isolates with ≤2 allelic differences between them, suggesting a relapse, and 2 had isolates differing by >50 allelic differences, suggesting reinfection. Conclusions: Our findings point to potential transmission of C. difficile in the community. WGS better differentiates relapse from reinfection than do definitions based on the timing of recurrence.
KW - Clostridioides difficile
KW - Clostridium difficile
KW - clinical outcomes
KW - ribotype
KW - whole-genome sequencing
UR - http://www.scopus.com/inward/record.url?scp=85100545075&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85100545075&partnerID=8YFLogxK
U2 - 10.1093/cid/ciaa159
DO - 10.1093/cid/ciaa159
M3 - Article
C2 - 32064535
AN - SCOPUS:85100545075
SN - 1058-4838
VL - 72
SP - 806
EP - 813
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 5
ER -