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1دورية أكاديمية
المصدر: Journal of the National Medical Association ; volume 115, issue 1, page 18-25 ; ISSN 0027-9684
مصطلحات موضوعية: General Medicine
الإتاحة: https://doi.org/10.1016/j.jnma.2022.12.006Test
https://api.elsevier.com/content/article/PII:S0027968422001900?httpAccept=text/xmlTest
https://api.elsevier.com/content/article/PII:S0027968422001900?httpAccept=text/plainTest -
2دورية أكاديمية
المؤلفون: Cho, Janice, Cunningham, Scott, Pu, Meng, Lennon, Ryan J, Dens Higano, Jennifer, Jeraldo, Patricio, Sampathkumar, Priya, Shannon, Samantha, Kashyap, Purna C, Patel, Robin
المصدر: Clin Infect Dis
مصطلحات موضوعية: Major Articles and Commentaries, envir, demo
الوصف: 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.
