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Diagn Microbiol Infect Dis. 2017 Jan;87(1):11-16. doi: 10.1016/j.diagmicrobio.2016.09.023. Epub 2016 Oct 5.

Determining the cause of recurrent Clostridium difficile infection using whole genome sequencing.

Author information

1
Department of Pathology, Stanford University, Stanford, CA, 94305.
2
One Codex, San Francisco, CA, 94110.
3
Clinical Microbiology Laboratory, Stanford University Medical Center, Palo Alto, CA, 94304.
4
Department of Biomolecular Engineering, University of California Santa Cruz, CA, 95064.
5
Department of Pathology, Stanford University, Stanford, CA, 94305; Clinical Microbiology Laboratory, Stanford University Medical Center, Palo Alto, CA, 94304; Department of Medicine, Stanford University, Stanford, CA, 94305. Electronic address: nbanaei@stanford.edu.

Abstract

Understanding the contribution of relapse and reinfection to recurrent Clostridium difficile infection (CDI) has implications for therapy and infection prevention, respectively. We used whole genome sequencing to determine the relation of C. difficile strains isolated from patients with recurrent CDI at an academic medical center in the United States. Thirty-five toxigenic C. difficile isolates from 16 patients with 19 recurrent CDI episodes with median time of 53.5days (range, 13-362) between episodes were whole genome sequenced on the Illumina MiSeq platform. In 84% (16) of recurrences, the cause of recurrence was relapse with prior strain of C. difficile. In 16% (3) of recurrent episodes, reinfection with a new strain of C. difficile was the cause. In conclusion, the majority of CDI recurrences at our institution were due to infection with the same strain rather than infection with a new strain.

KEYWORDS:

Clostridium difficile; Reinfection; Relapse

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