Canadian Journal of Infectious Diseases and Medical Microbiology

Agatha N. Jassem ¹, Natalie Prystajecky ¹, Fawziah Marra ¹, Pamela Kibsey ², Kennard Tan ², Patricia Umlandt ¹, Loretta Janz ¹, Sylvie Champagne ³, Bruce Gamage ⁴, George R. Golding ⁵, Michael R. Mulvey ⁵, Bonnie Henry ⁶, Linda M. N. Hoang ¹

Affiliations
1 British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, BC, V5Z 4R4, CA
2 Island Health, Victoria, BC, V6T 1Z3, CA
3 Providence Health Care, Vancouver, BC, V6Z 1Y6, CA
4 Provincial Infection Control Network of British Columbia, Vancouver, BC, V6H 4B1, CA
5 National Microbiology Laboratory, Winnipeg, MB, R3E 3R2, CA
6 School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z3, CA

Abstract

Background: Clostridium difficile is a major cause of gastrointestinal illness. Epidemic NAP1 strains contain toxins A and B, a deletion in repressor tcdC, and a binary toxin. Objectives: To determine the molecular epidemiology of C. difficile in British Columbia and compare between two time points in one region. Methods: C. difficile isolates from hospital and community laboratories (2008) and one Island Health hospital laboratory (2013) were characterized by pulsed-field gel electrophoresis, PCR-ribotyping, toxin possession, tcdC genotype, and antimicrobial susceptibility. Results: In 2008, 42.7% of isolates had NAP1 designation. Hospitalcollected isolates were associated with older patients and more NAP1 types. Unlike other isolates, most NAP1 isolates possessed binary toxin and a 19 bp loss in tcdC. All isolates were susceptible to metronidazole and vancomycin. A 2013 follow-up revealed a 28.9% decrease in NAP1 isolates and 20.0% increase in isolates without NAP designation in one region. Then, community-associated cases were seen in younger patients, while NAP types were evenly distributed. Isolates without NAP designation did not cluster with a PFGE pattern or ribotype. Conclusions: Evaluation of C. difficile infections within British Columbia revealed demographic associations, epidemiological shifts, and characteristics of strain types. Continuous surveillance of C. difficile will enable detection of emerging strains.

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