Community-acquired clostridium difficile infection: An increasing public health threat

Infection and Drug Resistance

Volumn 7, Issue , 2014, Pages 63-72

  Gupta, Arjun ^a   Khanna, Sahil ^a  

^a MAYO CLINIC   (United States)

Author keywords

Clostridium difficile; Community acquired infection; Epidemiology; Outcome; Risk factors

Indexed keywords

BETA LACTAM; BETA LACTAMASE INHIBITOR; CLINDAMYCIN; MACROLIDE; PENICILLIN DERIVATIVE; QUINOLONE DERIVATIVE; SULFONAMIDE;

AGE; BACTERIAL STRAIN; BACTERIUM ISOLATION; CLOSTRIDIUM DIFFICILE; CLOSTRIDIUM DIFFICILE INFECTION; COMMUNICABLE DISEASE; COMORBIDITY; DISEASE TRANSMISSION; FOOD CONTAMINATION; HUMAN; MOLECULAR TYPING; NONHUMAN; OUTCOME ASSESSMENT; OUTPATIENT CARE; PUBLIC HEALTH; REVIEW; RISK FACTOR; STOMACH ACID SECRETION;

EID: 84897824639     PISSN: 11786973     EISSN: None     Source Type: Journal    
DOI: 10.2147/IDR.S46780     Document Type: Review

References (141)

1. Kelly CP, LaMont JT. Clostridium difficile - more diffcult than ever. N Engl J Med. 2008;359(18):1932-1940.
2. Bartlett JG, Chang TW, Gurwith M, Gorbach SL, Onderdonk AB. Antibiotic-associated pseudomembranous colitis due to toxin-producing clostridia. N Engl J Med. 1978;298(10):531-534.
3. [No authors listed]. Severe Clostridium difficile-associated disease in populations previously at low risk - four states, 2005. MMWR Morb Mortal Wkly Rep. 2005;54(47):1201-1205.
4. Khanna S, Pardi DS. The growing incidence and severity of Clostridium difficile infection in inpatient and outpatient settings. Expert Rev Gastroenterol Hepatol. 2010;4(4):409-416.
5. Loo VG, Poirier L, Miller MA, et al. A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med. 2005;353(23):2442-2449.
6. McDonald LC, Killgore GE, Thompson A, et al. An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med. 2005;353(23): 2433-2441.
7. Muto CA, Pokrywka M, Shutt K, et al. A large outbreak of Clostridium difficile-associated disease with an unexpected proportion of deaths and colectomies at a teaching hospital following increased fuoroquinolone use. Infect Control Hosp Epidemiol. 2005;26(3):273-280.
8. Pepin J, Alary ME, Valiquette L, et al. Increasing risk of relapse after treatment of Clostridium difficile colitis in Quebec, Canada. Clin Infect Dis. 2005;40(11):1591-1597.
9. Warny M, Pepin J, Fang A, et al. Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet. 2005;366(9491):1079-1084.
10. Miller BA, Chen LF, Sexton DJ, Anderson DJ. Comparison of the burdens of hospital-onset, healthcare facility-associated Clostridium difficile infection and of healthcare-associated infection due to methicillin-resistant Staphylococcus aureus in community hospitals. Infect Control Hosp Epidemiol. 2011;32(4):387-390.
11. Zilberberg MD, Shorr AF, Kollef MH. Growth and geographic variation in hospitalizations with resistant infections, United States, 2000-2005. Emerg Infect Dis. 2008;14(11):1756-1758.
12. Khanna S, Pardi DS, Aronson SL, et al. The epidemiology of community-acquired Clostridium difficile infection: a population-based study. Am J Gastroenterol. 2012;107(1):89-95.
13. Wilcox MH, Mooney L, Bendall R, Settle CD, Fawley WN. A case-control study of community-associated Clostridium difficile infection. J Antimicrob Chemother. 2008;62(2):388-396.
14. Bauer MP, Goorhuis A, Koster T, et al. Community-onset Clostridium difficile-associated diarrhoea not associated with antibiotic usage - two case reports with review of the changing epidemiology of Clostridium difficile-associated diarrhoea. Neth J Med. 2008;66(5):207-211.
15. McDonald LC, Coignard B, Dubberke E, et al. Recommendations for surveillance of Clostridium difficile-associated disease. Infect Control Hosp Epidemiol. 2007;28(2):140-145.
16. Cohen SH, Gerding DN, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol. 2010;31(5):431-455.
17. Fraser TG, Fatica C, Gordon SM. Necessary but not sufficient: a comparison of surveillance defnitions of Clostridium difficile- associated diarrhea. Infect Control Hosp Epidemiol. 2009;30(4):377-379.
18. Shears P, Prtak L, Duckworth R. Hospital-based epidemiology: a strategy for 'dealing with Clostridium difficile'. J Hosp Infect. 2010;74(4):319-325.
19. Campbell RJ, Giljahn L, Machesky K, et al. Clostridium difficile infection in Ohio hospitals and nursing homes during 2006. Infect Control Hosp Epidemiol. 2009;30(6):526-533.
20. Dallal RM, Harbrecht BG, Boujoukas AJ, et al. Fulminant Clostridium difficile: an underappreciated and increasing cause of death and complications. Ann Surg. 2002;235(3):363-372.
21. Zilberberg MD. Clostridium difficile-related hospitalizations among US adults, 2006. Emerg Infect Dis. 2009;15(1):122-124.
22. McDonald LC, Owings M, Jernigan DB. Clostridium difficile infection in patients discharged from US short-stay hospitals, 1996-2003. Emerg Infect Dis. 2006;12(3):409-415.
23. Pepin J, Valiquette L, Cossette B. Mortality attributable to nosocomial Clostridium difficile-associated disease during an epidemic caused by a hypervirulent strain in Quebec. CMAJ. 2005;173(9):1037-1042.
24. McFarland LV, Clarridge JE, Beneda HW, Raugi GJ. Fluoroquinolone use and risk factors for Clostridium difficile-associated disease within a Veterans Administration health care system. Clin Infect Dis. 2007;45(9): 1141-1151.
25. Dial S, Delaney JA, Barkun AN, Suissa S. Use of gastric acid-suppressive agents and the risk of community-acquired Clostridium difficile-associated disease. JAMA. 2005;294(23):2989-2995.
26. Noren T, Akerlund T, Back E, et al. Molecular epidemiology of hospital-associated and community-acquired Clostridium difficile infection in a Swedish county. J Clin Microbiol. 2004;42(8):3635-3643.
27. Beaugerie L, Flahault A, Barbut F, et al. Antibiotic-associated diarrhoea and Clostridium difficile in the community. Aliment Pharmacol Ther. 2003;17(7):905-912.
28. Frost F, Hurley JS, Petersen HV, Casciano RN. Estimated incidence of Clostridium difficile infection. Emerg Infect Dis. 1999;5(2): 303-304.
29. Kutty PK, Woods C W, Sena AC, et al. Risk factors for and estimated incidence of community-associated Clostridium difficile infection, North Carolina, USA. Emerg Infect Dis. 2010;16(2):197-204.
30. Lambert PJ, Dyck M, Thompson LH, Hammond GW. Population-based surveillance of Clostridium difficile infection in Manitoba, Canada, by using interim surveillance defnitions. Infect Control Hosp Epidemiol. 2009;30(10):945-951.
31. Naggie S, Miller BA, Zuzak KB, et al. A case-control study of community-associated Clostridium difficile infection: no role for proton pump inhibitors. Am J Med. 2011;124(3):e271-e277.
32. Kim J, Smathers SA, Prasad P, Leckerman KH, Coffn S, Zaoutis T. Epidemiological features of Clostridium difficile-associated disease among inpatients at children's hospitals in the United States, 2001-2006. Pediatrics. 2008;122(6):1266-1270.
33. [No authors listed]. Surveillance for community-associated Clostrid-ium difficile - Connecticut, 2006. MMWR Morb Mortal Wkly Rep. 2008;57(13):340-343.
34. Morris AM, Jobe BA, Stoney M, Sheppard BC, Deveney CW, Deveney KE. Clostridium difficile colitis: an increasingly aggressive iatrogenic disease? Arch Surg. 2002;137(10):1096-1100.
35. Dial S, Kezouh A, Dascal A, Barkun A, Suissa S. Patterns of antibiotic use and risk of hospital admission because of Clostridium difficile infection. CMAJ. 2008;179(8):767-772.
36. Kuntz JL, Chrischilles EA, Pendergast J F, Herwaldt LA, Polgreen PM. Incidence of and risk factors for community-associated Clostridium difficile infection: a nested case-control study. BMC Infect Dis. 2011;11:194.
37. Chitnis AS, Holzbauer SM, Belfower RM, et al. Epidemiology of community-associated Clostridium difficile infection, 2009 through 2011. JAMA Intern Med. 2013;173(14):1359-1367.
38. Deshpande A, Pasupuleti V, Thota P, et al. Community-associated Clostridium difficile infection and antibiotics: a meta-analysis. J Antimicrob Chemother. 2013;68(9):1951-1961.
39. Brown KA, Khanafer N, Daneman N, Fisman DN. Meta-analysis of antibiotics and the risk of community-associated Clostridium difficile infection. Antimicrob Agents Chemother. 2013;57(5):2326-2332.
40. Dumyati G, Stevens V, Hannett GE, et al. Community-associated Clostridium difficile infections, Monroe County, New York, USA. Emerg Infect Dis. 2012;18(3):392-400.
41. Fellmeth G, Yarlagadda S, Iyer S. Epidemiology of community-onset Clostridium difficile infection in a community in the South of England. J Infect Public Health. 2010;3(3):118-123.
42. Khanna S, Baddour LM, Huskins WC, et al. The epidemiology of Clostridium difficile infection in children: a population-based study. Clin Infect Dis. 2013;56(10):1401-1406.
43. Baker SS, Faden H, Sayej W, Patel R, Baker RD. Increasing incidence of community-associated atypical Clostridium difficile disease in children. Clin Pediatr (Phila). 2010;49(7):644-647.
44. Benson L, Song X, Campos J, Singh N. Changing epidemiology of Clostridium difficile-associated disease in children. Infect Control Hosp Epidemiol. 2007;28(11):1233-1235.
45. Rao A, Jump RL, Pultz NJ, Pultz MJ, Donskey CJ. In vitro killing of nosocomial pathogens by acid and acidifed nitrite. Antimicrob Agents Chemother. 2006;50(11):3901-3904.
46. Wilson KH, Sheagren JN, Freter R. Population dynamics of ingested Clostridium difficile in the gastrointestinal tract of the Syrian hamster. J Infect Dis. 1985;151(2):355-361.
47. Williams C. Occurrence and signifcance of gastric colonization during acid-inhibitory therapy. Best Practice Res Clin Gastroenterol. 2001;15(3):511-521.
48. Dial S, Delaney JA, Schneider V, Suissa S. Proton pump inhibitor use and risk of community-acquired Clostridium difficile-associated disease defned by prescription for oral vancomycin therapy. CMAJ. 2006;175(7):745-748.
49. Janarthanan S, Ditah I, Adler DG, Ehrinpreis MN. Clostridium difficile-associated diarrhea and proton pump inhibitor therapy: a meta-analysis. Am J Gastroenterol. 2012;107(7):1001-1010.
50. Kwok CS, Arthur AK, Anibueze CI, Singh S, Cavallazzi R, Loke YK. Risk of Clostridium difficile infection with acid suppressing drugs and antibiotics: meta-analysis. Am J Gastroenterol. 2012;107(7): 1011-1019.
51. Pepin J, Saheb N, Coulombe MA, et al. Emergence of fuoroquinolo-nes as the predominant risk factor for Clostridium difficile-associated diarrhea: a cohort study during an epidemic in Quebec. Clin Infect Dis. 2005;41(9):1254-1260.
52. Khanna S, Aronson SL, Kammer PP, Baddour LM, Pardi DS. Gastric acid suppression and outcomes in Clostridium difficile infection: a population-based study. Mayo Clin Proc. 2012;87(7):636-642.
53. Freedberg DE, Abrams JA. Clostridium difficile infection in the community: are proton pump inhibitors to blame? World J Gastroenterol. 2013;19(40):6710-6713.
54. Stevens V, Dumyati G, Brown J, Wijngaarden E. Differential risk of Clostridium difficile infection with proton pump inhibitor use by level of antibiotic exposure. Pharmacoepidemiol Drug Saf. 2011;20(10): 1035-1042.
55. Khanna S, Pardi DS. IBD: poor outcomes after Clostridium difficile infection in IBD. Nat Rev Gastroenterol Hepatol. 2012;9(6):307-308.
56. Patriarchi F, Rolla M, Maccioni F, et al. Clostridium difficile-related pancolitis in lung-transplanted patients with cystic fibrosis. Clin Transplant. 2011;25(1):E46-E51.
57. Ananthakrishnan AN, McGinley EL, Binion DG. Excess hospi-talisation burden associated with Clostridium difficile in patients with infammatory bowel disease. Gut. 2008;57(2):205-210.
58. Kyne L, Sougioultzis S, McFarland LV, Kelly CP. Underlying disease severity as a major risk factor for nosocomial Clostridium difficile diarrhea. Infect Control Hosp Epidemiol. 2002;23(11):653-659.
59. Khanna S, Tosh PK. A clinician's primer on the role of the microbiome in human health and disease. Mayo Clin Proc. 2014;89(1):107-114.
60. Issa M, Vijayapal A, Graham MB, et al. Impact of Clostridium difficile on infammatory bowel disease. Clin Gastroenterol Hepatol. 2007;5(3):345-351.
61. Rodemann JF, Dubberke ER, Reske KA, Da Seo H, Stone CD. Incidence of Clostridium difficile infection in infammatory bowel disease. Clin Gastroenterol Hepatol. 2007;5(3):339-344.
62. Issa M, Ananthakrishnan AN, Binion DG. Clostridium difficile and infammatory bowel disease. Infamm Bowel Dis. 2008;14(10): 1432-1442.
63. Kelsen JR, Kim J, Latta D, et al. Recurrence rate of clostridium difficile infection in hospitalized pediatric patients with infammatory bowel disease. Infamm Bowel Dis. 2011;17(1):50-55.
64. Keddis MT, Khanna S, Noheria A, Baddour LM, Pardi DS, Qian Q. Clostridium difficile infection in patients with chronic kidney disease. Mayo Clin Proc. 2012;87(11):1046-1053.
65. Cunney RJ, Magee C, McNamara E, Smyth EG, Walshe J. Clostridium difficile colitis associated with chronic renal failure. Nephrol Dial Transplant. 1998;13(11):2842-2846.
66. Eddi R, Malik MN, Shakov R, Baddoura WJ, Chandran C, Debari VA. Chronic kidney disease as a risk factor for Clostridium difficile infection. Nephrology (Carlton). 2010;15(4):471-475.
67. Khanna S, Keddis MT, Noheria A, Baddour LM, Pardi DS. Acute kidney injury is an independent marker of severity in Clostridium dif-fcile infection: a nationwide survey. J Clin Gastroenterol. 2013;47(6): 481-484.
68. Schneeweiss S, Korzenik J, Solomon DH, Canning C, Lee J, Bressler B. Infiximab and other immunomodulating drugs in patients with infam-matory bowel disease and the risk of serious bacterial infections. Aliment Pharmacol Ther. 2009;30(3):253-264.
69. Das R, Feuerstadt P, Brandt LJ. Glucocorticoids are associated with increased risk of short-term mortality in hospitalized patients with Clostridium difficile-associated disease. Am J Gastroenterol. 2010;105(9):2040-2049.
70. Gellad ZF, Alexander BD, Liu JK, et al. Severity of Clostridium difficile-associated diarrhea in solid organ transplant patients. Transpl Infect Dis. 2007;9(4):276-280.
71. Kariv R, Navaneethan U, Venkatesh PG, Lopez R, Shen B. Impact of Clostridium difficile infection in patients with ulcerative colitis. J Crohns Colitis. 2011;5(1):34-40.
72. Ansari J, Choo B, Fernando I. Fatal Clostridium difficile infection associated with vinorelbine chemotherapy: case report and literature review. J Infect Chemother. 2010;16(3):210-212.
73. Sanchez TH, Brooks JT, Sullivan PS, et al. Bacterial diarrhea in persons with HIV infection, United States, 1992-2002. Clin Infect Dis. 2005;41(11):1621-1627.
74. Arango JI, Restrepo A, Schneider DL, et al. Incidence of Clostridium difficile-associated diarrhea before and after autologous peripheral blood stem cell transplantation for lymphoma and multiple myeloma. Bone Marrow Transplant. 2006;37(5):517-521.
75. Tomblyn M, Gordon L, Singhal S, et al. Rarity of toxigenic Clostridium difficile infections after hematopoietic stem cell transplantation: implications for symptomatic management of diarrhea. Bone Marrow Transplant. 2002;30(8):517-519.
76. Bobak D, Arfons LM, Creger RJ, Lazarus HM. Clostridium difficile-asso-ciated disease in human stem cell transplant recipients: coming epidemic or false alarm? Bone Marrow Transplant. 2008;42(11): 705-713.
77. Jillella AP, Ustun C, Robach E, et al. Infectious complications in patients receiving mobilization chemotherapy for autologous peripheral blood stem cell collection. J Hematother Stem Cell Res. 2003;12(2): 155-160.
78. Alonso CD, Treadway SB, Hanna DB, et al. Epidemiology and outcomes of Clostridium difficile infections in hematopoietic stem cell transplant recipients. Clin Infect Dis. 2012;54(8):1053-1063.
79. Neofytos D, Kobayashi K, Alonso CD, et al. Epidemiology, risk factors, and outcomes of Clostridium difficile infection in kidney transplant recipients. Transpl Infect Dis. 2013;15(2):134-141.
80. Dubberke ER, Gerding DN, Classen D, et al. Strategies to prevent clostridium difficile infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008;29 Suppl 1:S81-S92.
81. Shaughnessy MK, Micielli RL, DePestel DD, et al. Evaluation of hospital room assignment and acquisition of Clostridium difficile infection. Infect Control Hosp Epidemiol. 2011;32(3):201-206.
82. Dubberke ER, Reske KA, Noble-Wang J, et al. Prevalence of Clostridium difficile environmental contamination and strain variability in multiple health care facilities. Am J Infect Control. 2007;35(5): 315-318.
83. Kim KH, Fekety R, Batts DH, et al. Isolation of Clostridium difficile from the environment and contacts of patients with antibiotic-associated colitis. J Infect Dis. 1981;143(1):42-50.
84. Eyre DW, Cule ML, Wilson DJ, et al. Diverse sources of Clostridium difficile infection identifed on whole-genome sequencing. N Engl J Med. 2013;369(13):1195-1205.
85. Otten AM, Reid-Smith RJ, Fazil A, Weese JS. Disease transmission model for community-associated Clostridium difficile infection. Epidemiol Infect. 2010;138(6):907-914.
86. Bavishi C, Dupont HL. Systematic review: the use of proton pump inhibitors and increased susceptibility to enteric infection. Aliment Pharmacol Ther. 2011;34(11-12):1269-1281.
87. Ozaki E, Kato H, Kita H, et al. Clostridium difficile colonization in healthy adults: transient colonization and correlation with enterococcal colonization. J Med Microbiol. 2004;53 Pt 2:167-172.
88. Riggs MM, Sethi AK, Zabarsky TF, Eckstein EC, Jump RL, Donskey CJ. Asymptomatic carriers are a potential source for transmission of epidemic and nonepidemic Clostridium difficile strains among long-term care facility residents. Clin Infect Dis. 2007;45(8): 992-998.
89. Clabots CR, Johnson S, Olson MM, Peterson LR, Gerding DN. Acquisition of Clostridium difficile by hospitalized patients: evidence for colonized new admissions as a source of infection. J Infect Dis. 1992;166(3):561-567.
90. Kim JH, Toy D, Muder RR. Clostridium difficile infection in a long-term care facility: hospital-associated illness compared with long-term care-associated illness. Infect Control Hosp Epidemiol. 2011;32(7): 656-660.
91. Marwick CA, Yu N, Lockhart MC, et al. Community-associated Clostridium difficile infection among older people in Tayside, Scotland, is associated with antibiotic exposure and care home residence: cohort study with nested case-control. J Antimicrob Chemother. 2013;68(12): 2927-2933.
92. Stoesser N, Crook DW, Fung R, et al. Molecular epidemiology of Clostridium difficile strains in children compared with that of strains circulating in adults with Clostridium difficile-associated infection. J Clin Microbiol. 2011;49(11):3994-3996.
93. Rousseau C, Lemee L, Le Monnier A, Poilane I, Pons JL, Collignon A. Prevalence and diversity of Clostridium difficile strains in infants. J Med Microbiol. 2011;60 Pt 8:1112-1118.
94. Leffer DA, Lamont JT. Editorial: not so nosocomial anymore: the growing threat of community-acquired Clostridium difficile. Am J Gastroenterol. 2012;107(1):96-98.
95. Jury LA, Sitzlar B, Kundrapu S, et al. Outpatient healthcare settings and transmission of Clostridium difficile. PLoS One. 2013;8(7):e70175.
96. Sethi AK, Al-Nassir WN, Nerandzic MM, Bobulsky GS, Donskey CJ. Persistence of skin contamination and environmental shedding of Clostridium difficile during and after treatment of Clostridium difficile infection. Infect Control Hosp Epidemiol. 2010;31(1):21-27.
97. Weese JS. Clostridium difficile in food - innocent bystander or serious threat? Clin Microbiol Infect. 2010;16(1):3-10.
98. Jhung MA, Thompson AD, Killgore GE, et al. Toxinotype V Clostridium difficile in humans and food animals. Emerg Infect Dis. 2008;14(7):1039-1045.
99. Rupnik M. Is Clostridium difficile-associated infection a potentially zoonotic and foodborne disease? Clin Microbiol Infect. 2007;13(5): 457-459.
100. Rodriguez-Palacios A, Reid-Smith RJ, Staempfi HR, Weese JS. Clostridium difficile survives minimal temperature recommended for cooking ground meats. Anaerobe. 2010;16(5):540-542.
101. Avbersek J, Janezic S, Pate M, et al. Diversity of Clostridium difficile in pigs and other animals in Slovenia. Anaerobe. 2009;15(6): 252-255.
102. Weese JS, Avery BP, Rousseau J, Reid-Smith RJ. Detection and enumeration of Clostridium difficile spores in retail beef and pork. Appl Environmen Microbiol. 2009;75(15):5009-5011.
103. Indra A, Lassnig H, Baliko N, et al. Clostridium difficile: a new zoonotic agent? Wien Klin Wochenschr. 2009;121(3-4):91-95.
104. Pirs T, Ocepek M, Rupnik M. Isolation of Clostridium difficile from food animals in Slovenia. J Med Microbiol. 2008;57 Pt 6:790-792.
105. Keel MK, Songer JG. The distribution and density of Clostridium difficile toxin receptors on the intestinal mucosa of neonatal pigs. Vet Pathol. 2007;44(6):814-822.
106. Rodriguez-Palacios A, Stampfi HR, Duffeld T, et al. Clostridium dif-fcile PCR ribotypes in calves, Canada. Emerg Infect Dis. 2006;12(11): 1730-1736.
107. Arroyo LG, Kruth SA, Willey BM, Staempfi HR, Low DE, Weese JS. PCR ribotyping of Clostridium difficile isolates originating from human and animal sources. J Med Microbiol. 2005;54 Pt 2: 163-166.
108. Gould LH, Limbago B. Clostridium difficile in food and domestic animals: a new foodborne pathogen? Clin Infect Dis. 2010;51(5): 577-582.
109. Songer JG, Trinh HT, Killgore GE, Thompson AD, McDonald LC, Limbago BM. Clostridium difficile in retail meat products, USA, 2007. Emerg Infect Dis. 2009;15(5):819-821.
110. Goorhuis A, Bakker D, Corver J, et al. Emergence of Clostridium difficile infection due to a new hypervirulent strain, polymerase chain reaction ribotype 078. Clin Infect Dis. 2008;47(9):1162-1170.
111. Bakker D, Corver J, Harmanus C, et al. Relatedness of human and animal Clostridium difficile PCR ribotype 078 isolates determined on the basis of multilocus variable-number tandem-repeat analysis and tetracycline resistance. J Clin Microbiol. 2010;48(10): 3744-3749.
112. Marsh JW. Counterpoint: is Clostridium difficile a food-borne disease? Anaerobe. 2013;21:62-63.
113. Riley TV, Thean S, Hool G, Golledge CL. First Australian isolation of epidemic Clostridium difficile PCR ribotype 027. Med J Aust. 2009;190(12):706-708.
114. Bacci S, St-Martin G, Olesen B, et al. Outbreak of Clostridium difficile 027 in North Zealand, Denmark, 2008-2009. Euro Surveill. 2009; 14(16). p: 19183.
115. Pituch H, Bakker D, Kuijper E, et al. First isolation of Clostridium difficile PCR-ribotype 027/toxinotype III in Poland. Pol J Microbiol. 2008;57(3):267-268.
116. Notermans DW, Van Der Kooi TI, Goorhuis A, Debast SB, van Benthem BH, Kuijper EJ. Epidemiology of Clostridium difficile PCR ribotype 027 in The Netherlands 2005-present and the emergence of other subtypes. Ned Tijdschr Geneeskd. 2008;152(35):1937-1940. Dutch.
117. Goorhuis A, Van Der Kooi T, Vaessen N, et al. Spread and epidemiology of Clostridium difficile polymerase chain reaction ribotype 027/toxinotype III in The Netherlands. Clin Infect Dis. 2007;45(6): 695-703.
118. Joseph R, Demeyer D, Vanrenterghem D, Van Den Berg R, Kuijper E, Delmee M. First isolation of Clostridium difficile PCR ribotype 027, toxinotype III in Belgium. Euro Surveill. 2005;10(10): E051020-E051024.
119. Bauer MP, Notermans DW, Van Benthem BH, et al. Clostridium difficile infection in Europe: a hospital-based survey. Lancet. 2011; 377(9759):63-73.
120. Hensgens MP, Goorhuis A, Notermans DW, van Benthem BH, Kuijper EJ. Decrease of hypervirulent Clostridium difficile PCR ribo-type 027 in The Netherlands. Euro Surveill. 2009;14(45). pii: 19402
121. De Almeida MN, Heffernan H, Dervan A, et al. Severe Clostridium difficile infection in New Zealand associated with an emerging strain, PCR-ribotype 244. N Z Med J. 2013;126(1380):9-14.
122. Tagashira Y, Kato H, Senoh M, Nakamura A. Two cases of fulminant colitis due to binary toxin-positive Clostridium difficile that are not PCR ribotype 027 or type 078. J Med Microbiol. 2013;62 Pt 9: 1486-1489.
123. Bignardi GE, Settle C. Different ribotypes in community-acquired Clostridium difficile. J Hosp Infect. 2008;70(1):96-98.
124. Belmares J, Johnson S, Parada JP, et al. Molecular epidemiology of Clostridium difficile over the course of 10 years in a tertiary care hospital. Clin Infect Dis. 2009;49(8):1141-1147.
125. Killgore G, Thompson A, Johnson S, et al. Comparison of seven techniques for typing international epidemic strains of Clostridium difficile: restriction endonuclease analysis, pulsed-feld gel electro-phoresis, PCR-ribotyping, multilocus sequence typing, multilocus variable-number tandem-repeat analysis, amplifed fragment length polymorphism, and surface layer protein A gene sequence typing. J Clin Microbiol. 2008;46(2):431-437.
126. Knetsch CW, Lawley TD, Hensgens MP, Corver J, Wilcox MW, Kuijper EJ. Current application and future perspectives of molecular typing methods to study Clostridium difficile infections. Euro Surveill. 2013;18(4):20381.
127. Marsh JW, O'Leary MM, Shutt KA, et al. Multilocus variable-number tandem-repeat analysis for investigation of Clostridium difficile transmission in Hospitals. J Clin Microbiol. 2006;44(7): 2558-2566.
128. Eyre DW, Golubchik T, Gordon NC, et al. A pilot study of rapid benchtop sequencing of Staphylococcus aureus and Clostridium dif-fcile for outbreak detection and surveillance. BMJ Open. 2012;2(3). pii: e001124.
129. Eyre DW, Fawley WN, Best EL, et al. Comparison of multilo-cus variable-number tandem-repeat analysis and whole-genome sequencing for investigation of Clostridium difficile transmission. J Clin Microbiol. 2013;51(12):4141-4149.
130. Walker AS, Eyre DW, Wyllie DH, et al. Relationship between bacterial strain type, host biomarkers, and mortality in Clostridium difficile infection. Clin Infect Dis. 2013;56(11):1589-1600.
131. Smits WK. Hype or hypervirulence: a refection on problematic Clostridium difficile strains. Virulence. 2013;4(7):592-596.
132. Shin BM, Moon SJ, Kim YS, Shin WC, Yo o HM. Characterization of cases of Clostridium difficile infection (CDI) presenting at an emergency room: molecular and clinical features differentiate community-onset hospital-associated and community-associated CDI in a tertiary care hospital. J Clin Microbiol. 2011;49(6):2161-2165.
133. MacCannell DR, Louie TJ, Gregson DB, et al. Molecular analysis of Clostridium difficile PCR ribotype 027 isolates from Eastern and Western Canada. J Clin Microbiol. 2006;44(6):2147-2152.
134. Limbago BM, Long CM, Thompson AD, et al. Clostridium difficile strains from community-associated infections. J Clin Microbiol. 2009;47(9):3004-3007.
135. Rupnik M. Heterogeneity of large clostridial toxins: importance of Clostridium difficile toxinotypes. FEMS Microbiol Rev. 2008;32(3): 541-555.
136. Bauer MP, Veenendaal D, Verhoef L, Bloembergen P, Van Dissel JT, Kuijper EJ. Clinical and microbiological characteristics of community-onset Clostridium difficile infection in The Netherlands. Clin Microbiol Infect. 2009;15(12):1087-1092.
137. Miller M, Gravel D, Mulvey M, et al. Health care-associated Clostridium difficile infection in Canada: patient age and infecting strain type are highly predictive of severe outcome and mortality. Clin Infect Dis. 2010;50(2):194-201.
138. Henrich TJ, Krakower D, Bitton A, Yokoe DS. Clinical risk factors for severe Clostridium difficile-associated disease. Emerg Infect Dis. 2009;15(3):415-422.
139. Lamontagne F, Labbe AC, Haeck O, et al. Impact of emergency colectomy on survival of patients with fulminant Clostridium difficile colitis during an epidemic caused by a hypervirulent strain. Ann Surg. 2007;245(2):267-272.
140. Moshkowitz M, Ben-Baruch E, Kline Z, Shimoni Z, Niven M, Konikoff F. Risk factors for severity and relapse of pseudomembranous colitis in an elderly population. Colorectal Dis. 2007;9(2):173-177.
141. Khanna S, Pardi DS, Aronson SL, Kammer PP, Baddour LM. Outcomes in community-acquired Clostridium difficile infection. Aliment Pharmacol Ther. 2012;35(5):613-618.