Evidence map›Paper›PMID 24066741›Full record

ArticleThe New England journal of medicine2013

Diverse sources of C. difficile infection identified on whole-genome sequencing.

David W Eyre, Madeleine L Cule, Daniel J Wilson, David Griffiths, Alison Vaughan, Lily O'Connor, Camilla L C Ip, Tanya Golubchik, Elizabeth M Batty, John M Finney and 10 more

Open access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The New England journal of medicine, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 336 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
336citing papers in PubMed, 3 pooled it
39.4field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

336 citing papers in PubMed, 3 syntheses or guidelines pooled it, 638 citations in OpenAlex.

  1. Pooled it
  2. Guideline
  3. Pooled it
  4. Cost-effectiveness of an Environmental Cleaning Bundle for Reducing Healthcare-associated Infections.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2020
    Trial
  5. Trial
  6. The prevalence and molecular epidemiology ofEmerging microbes & infections · 2026
    Observational
  7. BeyondEmerging microbes & infections · 2026
    Article
  8. Article
  9. Article
  10. Article
  11. Article
  12. Article
  13. High thermal resistance and inactivation behaviour of Clostridioides difficile spores in milk.Brazilian journal of microbiology : [publication of the Brazilian Society for Microbiology] · 2026
    Article
  14. Review
  15. Article
  16. Microbiology spectrum · 2026
    Article
  17. Frontiers in microbiology · 2026
    Article
  18. Clinical and molecular epidemiology ofFrontiers in microbiology · 2026
    Article
  19. Article
  20. Changes in the Epidemiology of Clostridioides difficile Infection.Infectious disease clinics of North America · 2025
    Review

276 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

20 authors at 6 institutions in 3 countries.

David W EyreNuffield Department of Clinical Medicine (D.W.E., D.J.W., D.G., A.V., L.O., J.M.F., D.H.W., K.E.D., D.W.C., T.E.A.P., A.S.W.), and the Departments of Statistics (M.L.C., C.L.C.I., T.G., X.D., R.B.) and Zoology (R.M.H.), University of Oxford, the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, John Radcliffe Hospital (D.W.E., M.L.C., D.G., A.V., C.L.C.I., T.G., E.M.B., J.M.F., D.H.W., X.D., R.B., K.E.D., R.M.H., D.W.C., T.E.A.P., A.S.W.), Wellcome Trust Centre for Human Genetics (D.J.W., E.M.B., P.P., R.B.), and Oxford University Hospitals National Health Service Trust (L.O., D.W.C., T.E.A.P.), Oxford, the Leeds Teaching Hospitals and University of Leeds, Department of Microbiology, Leeds General Infirmary, Leeds (M.H.W.), and the Medical Research Council, Clinical Trials Unit, London (A.S.W.) - all in the United Kingdom.
Madeleine L CuleNuffield Department of Clinical Medicine (D.W.E., D.J.W., D.G., A.V., L.O., J.M.F., D.H.W., K.E.D., D.W.C., T.E.A.P., A.S.W.), and the Departments of Statistics (M.L.C., C.L.C.I., T.G., X.D., R.B.) and Zoology (R.M.H.), University of Oxford, the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, John Radcliffe Hospital (D.W.E., M.L.C., D.G., A.V., C.L.C.I., T.G., E.M.B., J.M.F., D.H.W., X.D., R.B., K.E.D., R.M.H., D.W.C., T.E.A.P., A.S.W.), Wellcome Trust Centre for Human Genetics (D.J.W., E.M.B., P.P., R.B.), and Oxford University Hospitals National Health Service Trust (L.O., D.W.C., T.E.A.P.), Oxford, the Leeds Teaching Hospitals and University of Leeds, Department of Microbiology, Leeds General Infirmary, Leeds (M.H.W.), and the Medical Research Council, Clinical Trials Unit, London (A.S.W.) - all in the United Kingdom.
Daniel J WilsonNuffield Department of Clinical Medicine (D.W.E., D.J.W., D.G., A.V., L.O., J.M.F., D.H.W., K.E.D., D.W.C., T.E.A.P., A.S.W.), and the Departments of Statistics (M.L.C., C.L.C.I., T.G., X.D., R.B.) and Zoology (R.M.H.), University of Oxford, the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, John Radcliffe Hospital (D.W.E., M.L.C., D.G., A.V., C.L.C.I., T.G., E.M.B., J.M.F., D.H.W., X.D., R.B., K.E.D., R.M.H., D.W.C., T.E.A.P., A.S.W.), Wellcome Trust Centre for Human Genetics (D.J.W., E.M.B., P.P., R.B.), and Oxford University Hospitals National Health Service Trust (L.O., D.W.C., T.E.A.P.), Oxford, the Leeds Teaching Hospitals and University of Leeds, Department of Microbiology, Leeds General Infirmary, Leeds (M.H.W.), and the Medical Research Council, Clinical Trials Unit, London (A.S.W.) - all in the United Kingdom.
David GriffithsNuffield Department of Clinical Medicine (D.W.E., D.J.W., D.G., A.V., L.O., J.M.F., D.H.W., K.E.D., D.W.C., T.E.A.P., A.S.W.), and the Departments of Statistics (M.L.C., C.L.C.I., T.G., X.D., R.B.) and Zoology (R.M.H.), University of Oxford, the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, John Radcliffe Hospital (D.W.E., M.L.C., D.G., A.V., C.L.C.I., T.G., E.M.B., J.M.F., D.H.W., X.D., R.B., K.E.D., R.M.H., D.W.C., T.E.A.P., A.S.W.), Wellcome Trust Centre for Human Genetics (D.J.W., E.M.B., P.P., R.B.), and Oxford University Hospitals National Health Service Trust (L.O., D.W.C., T.E.A.P.), Oxford, the Leeds Teaching Hospitals and University of Leeds, Department of Microbiology, Leeds General Infirmary, Leeds (M.H.W.), and the Medical Research Council, Clinical Trials Unit, London (A.S.W.) - all in the United Kingdom.
Alison VaughanNuffield Department of Clinical Medicine (D.W.E., D.J.W., D.G., A.V., L.O., J.M.F., D.H.W., K.E.D., D.W.C., T.E.A.P., A.S.W.), and the Departments of Statistics (M.L.C., C.L.C.I., T.G., X.D., R.B.) and Zoology (R.M.H.), University of Oxford, the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, John Radcliffe Hospital (D.W.E., M.L.C., D.G., A.V., C.L.C.I., T.G., E.M.B., J.M.F., D.H.W., X.D., R.B., K.E.D., R.M.H., D.W.C., T.E.A.P., A.S.W.), Wellcome Trust Centre for Human Genetics (D.J.W., E.M.B., P.P., R.B.), and Oxford University Hospitals National Health Service Trust (L.O., D.W.C., T.E.A.P.), Oxford, the Leeds Teaching Hospitals and University of Leeds, Department of Microbiology, Leeds General Infirmary, Leeds (M.H.W.), and the Medical Research Council, Clinical Trials Unit, London (A.S.W.) - all in the United Kingdom.
Lily O'ConnorNuffield Department of Clinical Medicine (D.W.E., D.J.W., D.G., A.V., L.O., J.M.F., D.H.W., K.E.D., D.W.C., T.E.A.P., A.S.W.), and the Departments of Statistics (M.L.C., C.L.C.I., T.G., X.D., R.B.) and Zoology (R.M.H.), University of Oxford, the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, John Radcliffe Hospital (D.W.E., M.L.C., D.G., A.V., C.L.C.I., T.G., E.M.B., J.M.F., D.H.W., X.D., R.B., K.E.D., R.M.H., D.W.C., T.E.A.P., A.S.W.), Wellcome Trust Centre for Human Genetics (D.J.W., E.M.B., P.P., R.B.), and Oxford University Hospitals National Health Service Trust (L.O., D.W.C., T.E.A.P.), Oxford, the Leeds Teaching Hospitals and University of Leeds, Department of Microbiology, Leeds General Infirmary, Leeds (M.H.W.), and the Medical Research Council, Clinical Trials Unit, London (A.S.W.) - all in the United Kingdom.
Camilla L C IpNuffield Department of Clinical Medicine (D.W.E., D.J.W., D.G., A.V., L.O., J.M.F., D.H.W., K.E.D., D.W.C., T.E.A.P., A.S.W.), and the Departments of Statistics (M.L.C., C.L.C.I., T.G., X.D., R.B.) and Zoology (R.M.H.), University of Oxford, the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, John Radcliffe Hospital (D.W.E., M.L.C., D.G., A.V., C.L.C.I., T.G., E.M.B., J.M.F., D.H.W., X.D., R.B., K.E.D., R.M.H., D.W.C., T.E.A.P., A.S.W.), Wellcome Trust Centre for Human Genetics (D.J.W., E.M.B., P.P., R.B.), and Oxford University Hospitals National Health Service Trust (L.O., D.W.C., T.E.A.P.), Oxford, the Leeds Teaching Hospitals and University of Leeds, Department of Microbiology, Leeds General Infirmary, Leeds (M.H.W.), and the Medical Research Council, Clinical Trials Unit, London (A.S.W.) - all in the United Kingdom.
Tanya GolubchikNuffield Department of Clinical Medicine (D.W.E., D.J.W., D.G., A.V., L.O., J.M.F., D.H.W., K.E.D., D.W.C., T.E.A.P., A.S.W.), and the Departments of Statistics (M.L.C., C.L.C.I., T.G., X.D., R.B.) and Zoology (R.M.H.), University of Oxford, the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, John Radcliffe Hospital (D.W.E., M.L.C., D.G., A.V., C.L.C.I., T.G., E.M.B., J.M.F., D.H.W., X.D., R.B., K.E.D., R.M.H., D.W.C., T.E.A.P., A.S.W.), Wellcome Trust Centre for Human Genetics (D.J.W., E.M.B., P.P., R.B.), and Oxford University Hospitals National Health Service Trust (L.O., D.W.C., T.E.A.P.), Oxford, the Leeds Teaching Hospitals and University of Leeds, Department of Microbiology, Leeds General Infirmary, Leeds (M.H.W.), and the Medical Research Council, Clinical Trials Unit, London (A.S.W.) - all in the United Kingdom.
Elizabeth M BattyNuffield Department of Clinical Medicine (D.W.E., D.J.W., D.G., A.V., L.O., J.M.F., D.H.W., K.E.D., D.W.C., T.E.A.P., A.S.W.), and the Departments of Statistics (M.L.C., C.L.C.I., T.G., X.D., R.B.) and Zoology (R.M.H.), University of Oxford, the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, John Radcliffe Hospital (D.W.E., M.L.C., D.G., A.V., C.L.C.I., T.G., E.M.B., J.M.F., D.H.W., X.D., R.B., K.E.D., R.M.H., D.W.C., T.E.A.P., A.S.W.), Wellcome Trust Centre for Human Genetics (D.J.W., E.M.B., P.P., R.B.), and Oxford University Hospitals National Health Service Trust (L.O., D.W.C., T.E.A.P.), Oxford, the Leeds Teaching Hospitals and University of Leeds, Department of Microbiology, Leeds General Infirmary, Leeds (M.H.W.), and the Medical Research Council, Clinical Trials Unit, London (A.S.W.) - all in the United Kingdom.
John M FinneyNuffield Department of Clinical Medicine (D.W.E., D.J.W., D.G., A.V., L.O., J.M.F., D.H.W., K.E.D., D.W.C., T.E.A.P., A.S.W.), and the Departments of Statistics (M.L.C., C.L.C.I., T.G., X.D., R.B.) and Zoology (R.M.H.), University of Oxford, the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, John Radcliffe Hospital (D.W.E., M.L.C., D.G., A.V., C.L.C.I., T.G., E.M.B., J.M.F., D.H.W., X.D., R.B., K.E.D., R.M.H., D.W.C., T.E.A.P., A.S.W.), Wellcome Trust Centre for Human Genetics (D.J.W., E.M.B., P.P., R.B.), and Oxford University Hospitals National Health Service Trust (L.O., D.W.C., T.E.A.P.), Oxford, the Leeds Teaching Hospitals and University of Leeds, Department of Microbiology, Leeds General Infirmary, Leeds (M.H.W.), and the Medical Research Council, Clinical Trials Unit, London (A.S.W.) - all in the United Kingdom.
David H WyllieNuffield Department of Clinical Medicine (D.W.E., D.J.W., D.G., A.V., L.O., J.M.F., D.H.W., K.E.D., D.W.C., T.E.A.P., A.S.W.), and the Departments of Statistics (M.L.C., C.L.C.I., T.G., X.D., R.B.) and Zoology (R.M.H.), University of Oxford, the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, John Radcliffe Hospital (D.W.E., M.L.C., D.G., A.V., C.L.C.I., T.G., E.M.B., J.M.F., D.H.W., X.D., R.B., K.E.D., R.M.H., D.W.C., T.E.A.P., A.S.W.), Wellcome Trust Centre for Human Genetics (D.J.W., E.M.B., P.P., R.B.), and Oxford University Hospitals National Health Service Trust (L.O., D.W.C., T.E.A.P.), Oxford, the Leeds Teaching Hospitals and University of Leeds, Department of Microbiology, Leeds General Infirmary, Leeds (M.H.W.), and the Medical Research Council, Clinical Trials Unit, London (A.S.W.) - all in the United Kingdom.
Xavier DidelotNuffield Department of Clinical Medicine (D.W.E., D.J.W., D.G., A.V., L.O., J.M.F., D.H.W., K.E.D., D.W.C., T.E.A.P., A.S.W.), and the Departments of Statistics (M.L.C., C.L.C.I., T.G., X.D., R.B.) and Zoology (R.M.H.), University of Oxford, the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, John Radcliffe Hospital (D.W.E., M.L.C., D.G., A.V., C.L.C.I., T.G., E.M.B., J.M.F., D.H.W., X.D., R.B., K.E.D., R.M.H., D.W.C., T.E.A.P., A.S.W.), Wellcome Trust Centre for Human Genetics (D.J.W., E.M.B., P.P., R.B.), and Oxford University Hospitals National Health Service Trust (L.O., D.W.C., T.E.A.P.), Oxford, the Leeds Teaching Hospitals and University of Leeds, Department of Microbiology, Leeds General Infirmary, Leeds (M.H.W.), and the Medical Research Council, Clinical Trials Unit, London (A.S.W.) - all in the United Kingdom.
Paolo PiazzaNuffield Department of Clinical Medicine (D.W.E., D.J.W., D.G., A.V., L.O., J.M.F., D.H.W., K.E.D., D.W.C., T.E.A.P., A.S.W.), and the Departments of Statistics (M.L.C., C.L.C.I., T.G., X.D., R.B.) and Zoology (R.M.H.), University of Oxford, the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, John Radcliffe Hospital (D.W.E., M.L.C., D.G., A.V., C.L.C.I., T.G., E.M.B., J.M.F., D.H.W., X.D., R.B., K.E.D., R.M.H., D.W.C., T.E.A.P., A.S.W.), Wellcome Trust Centre for Human Genetics (D.J.W., E.M.B., P.P., R.B.), and Oxford University Hospitals National Health Service Trust (L.O., D.W.C., T.E.A.P.), Oxford, the Leeds Teaching Hospitals and University of Leeds, Department of Microbiology, Leeds General Infirmary, Leeds (M.H.W.), and the Medical Research Council, Clinical Trials Unit, London (A.S.W.) - all in the United Kingdom.
Rory BowdenNuffield Department of Clinical Medicine (D.W.E., D.J.W., D.G., A.V., L.O., J.M.F., D.H.W., K.E.D., D.W.C., T.E.A.P., A.S.W.), and the Departments of Statistics (M.L.C., C.L.C.I., T.G., X.D., R.B.) and Zoology (R.M.H.), University of Oxford, the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, John Radcliffe Hospital (D.W.E., M.L.C., D.G., A.V., C.L.C.I., T.G., E.M.B., J.M.F., D.H.W., X.D., R.B., K.E.D., R.M.H., D.W.C., T.E.A.P., A.S.W.), Wellcome Trust Centre for Human Genetics (D.J.W., E.M.B., P.P., R.B.), and Oxford University Hospitals National Health Service Trust (L.O., D.W.C., T.E.A.P.), Oxford, the Leeds Teaching Hospitals and University of Leeds, Department of Microbiology, Leeds General Infirmary, Leeds (M.H.W.), and the Medical Research Council, Clinical Trials Unit, London (A.S.W.) - all in the United Kingdom.
Kate E DingleNuffield Department of Clinical Medicine (D.W.E., D.J.W., D.G., A.V., L.O., J.M.F., D.H.W., K.E.D., D.W.C., T.E.A.P., A.S.W.), and the Departments of Statistics (M.L.C., C.L.C.I., T.G., X.D., R.B.) and Zoology (R.M.H.), University of Oxford, the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, John Radcliffe Hospital (D.W.E., M.L.C., D.G., A.V., C.L.C.I., T.G., E.M.B., J.M.F., D.H.W., X.D., R.B., K.E.D., R.M.H., D.W.C., T.E.A.P., A.S.W.), Wellcome Trust Centre for Human Genetics (D.J.W., E.M.B., P.P., R.B.), and Oxford University Hospitals National Health Service Trust (L.O., D.W.C., T.E.A.P.), Oxford, the Leeds Teaching Hospitals and University of Leeds, Department of Microbiology, Leeds General Infirmary, Leeds (M.H.W.), and the Medical Research Council, Clinical Trials Unit, London (A.S.W.) - all in the United Kingdom.
Rosalind M HardingNuffield Department of Clinical Medicine (D.W.E., D.J.W., D.G., A.V., L.O., J.M.F., D.H.W., K.E.D., D.W.C., T.E.A.P., A.S.W.), and the Departments of Statistics (M.L.C., C.L.C.I., T.G., X.D., R.B.) and Zoology (R.M.H.), University of Oxford, the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, John Radcliffe Hospital (D.W.E., M.L.C., D.G., A.V., C.L.C.I., T.G., E.M.B., J.M.F., D.H.W., X.D., R.B., K.E.D., R.M.H., D.W.C., T.E.A.P., A.S.W.), Wellcome Trust Centre for Human Genetics (D.J.W., E.M.B., P.P., R.B.), and Oxford University Hospitals National Health Service Trust (L.O., D.W.C., T.E.A.P.), Oxford, the Leeds Teaching Hospitals and University of Leeds, Department of Microbiology, Leeds General Infirmary, Leeds (M.H.W.), and the Medical Research Council, Clinical Trials Unit, London (A.S.W.) - all in the United Kingdom.
Derrick W Crook *Nuffield Department of Clinical Medicine (D.W.E., D.J.W., D.G., A.V., L.O., J.M.F., D.H.W., K.E.D., D.W.C., T.E.A.P., A.S.W.), and the Departments of Statistics (M.L.C., C.L.C.I., T.G., X.D., R.B.) and Zoology (R.M.H.), University of Oxford, the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, John Radcliffe Hospital (D.W.E., M.L.C., D.G., A.V., C.L.C.I., T.G., E.M.B., J.M.F., D.H.W., X.D., R.B., K.E.D., R.M.H., D.W.C., T.E.A.P., A.S.W.), Wellcome Trust Centre for Human Genetics (D.J.W., E.M.B., P.P., R.B.), and Oxford University Hospitals National Health Service Trust (L.O., D.W.C., T.E.A.P.), Oxford, the Leeds Teaching Hospitals and University of Leeds, Department of Microbiology, Leeds General Infirmary, Leeds (M.H.W.), and the Medical Research Council, Clinical Trials Unit, London (A.S.W.) - all in the United Kingdom.
Mark H Wilcox *Nuffield Department of Clinical Medicine (D.W.E., D.J.W., D.G., A.V., L.O., J.M.F., D.H.W., K.E.D., D.W.C., T.E.A.P., A.S.W.), and the Departments of Statistics (M.L.C., C.L.C.I., T.G., X.D., R.B.) and Zoology (R.M.H.), University of Oxford, the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, John Radcliffe Hospital (D.W.E., M.L.C., D.G., A.V., C.L.C.I., T.G., E.M.B., J.M.F., D.H.W., X.D., R.B., K.E.D., R.M.H., D.W.C., T.E.A.P., A.S.W.), Wellcome Trust Centre for Human Genetics (D.J.W., E.M.B., P.P., R.B.), and Oxford University Hospitals National Health Service Trust (L.O., D.W.C., T.E.A.P.), Oxford, the Leeds Teaching Hospitals and University of Leeds, Department of Microbiology, Leeds General Infirmary, Leeds (M.H.W.), and the Medical Research Council, Clinical Trials Unit, London (A.S.W.) - all in the United Kingdom.
Tim E A Peto *Nuffield Department of Clinical Medicine (D.W.E., D.J.W., D.G., A.V., L.O., J.M.F., D.H.W., K.E.D., D.W.C., T.E.A.P., A.S.W.), and the Departments of Statistics (M.L.C., C.L.C.I., T.G., X.D., R.B.) and Zoology (R.M.H.), University of Oxford, the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, John Radcliffe Hospital (D.W.E., M.L.C., D.G., A.V., C.L.C.I., T.G., E.M.B., J.M.F., D.H.W., X.D., R.B., K.E.D., R.M.H., D.W.C., T.E.A.P., A.S.W.), Wellcome Trust Centre for Human Genetics (D.J.W., E.M.B., P.P., R.B.), and Oxford University Hospitals National Health Service Trust (L.O., D.W.C., T.E.A.P.), Oxford, the Leeds Teaching Hospitals and University of Leeds, Department of Microbiology, Leeds General Infirmary, Leeds (M.H.W.), and the Medical Research Council, Clinical Trials Unit, London (A.S.W.) - all in the United Kingdom.
A Sarah Walker *Nuffield Department of Clinical Medicine (D.W.E., D.J.W., D.G., A.V., L.O., J.M.F., D.H.W., K.E.D., D.W.C., T.E.A.P., A.S.W.), and the Departments of Statistics (M.L.C., C.L.C.I., T.G., X.D., R.B.) and Zoology (R.M.H.), University of Oxford, the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, John Radcliffe Hospital (D.W.E., M.L.C., D.G., A.V., C.L.C.I., T.G., E.M.B., J.M.F., D.H.W., X.D., R.B., K.E.D., R.M.H., D.W.C., T.E.A.P., A.S.W.), Wellcome Trust Centre for Human Genetics (D.J.W., E.M.B., P.P., R.B.), and Oxford University Hospitals National Health Service Trust (L.O., D.W.C., T.E.A.P.), Oxford, the Leeds Teaching Hospitals and University of Leeds, Department of Microbiology, Leeds General Infirmary, Leeds (M.H.W.), and the Medical Research Council, Clinical Trials Unit, London (A.S.W.) - all in the United Kingdom.
Oxford Biomedical Research · USJohn Radcliffe Hospital · GBNuffield Health · GBCentre for Human Genetics · GBNational Health Service · GBUniversity of Leeds · GB

Funding

Biotechnology and Biological Sciences Research CouncilDepartment of Health DRF-2010-03-40Department of Health G0800778Medical Research Council G0600719Medical Research Council G0800778Medical Research Council MR/K010174/1Wellcome Trust 087646Wellcome Trust 087646/Z/08/Z
6 · The paper itself

Abstract

backgroundIt has been thought that Clostridium difficile infection is transmitted predominantly within health care settings. However, endemic spread has hampered identification of precise sources of infection and the assessment of the efficacy of interventions.

methodsFrom September 2007 through March 2011, we performed whole-genome sequencing on isolates obtained from all symptomatic patients with C. difficile infection identified in health care settings or in the community in Oxfordshire, United Kingdom. We compared single-nucleotide variants (SNVs) between the isolates, using C. difficile evolution rates estimated on the basis of the first and last samples obtained from each of 145 patients, with 0 to 2 SNVs expected between transmitted isolates obtained less than 124 days apart, on the basis of a 95% prediction interval. We then identified plausible epidemiologic links among genetically related cases from data on hospital admissions and community location.

resultsOf 1250 C. difficile cases that were evaluated, 1223 (98%) were successfully sequenced. In a comparison of 957 samples obtained from April 2008 through March 2011 with those obtained from September 2007 onward, a total of 333 isolates (35%) had no more than 2 SNVs from at least 1 earlier case, and 428 isolates (45%) had more than 10 SNVs from all previous cases. Reductions in incidence over time were similar in the two groups, a finding that suggests an effect of interventions targeting the transition from exposure to disease. Of the 333 patients with no more than 2 SNVs (consistent with transmission), 126 patients (38%) had close hospital contact with another patient, and 120 patients (36%) had no hospital or community contact with another patient. Distinct subtypes of infection continued to be identified throughout the study, which suggests a considerable reservoir of C. difficile.

conclusionsOver a 3-year period, 45% of C. difficile cases in Oxfordshire were genetically distinct from all previous cases. Genetically diverse sources, in addition to symptomatic patients, play a major part in C. difficile transmission. (Funded by the U.K. Clinical Research Collaboration Translational Infection Research Initiative and others.).

Indexed as

AgedAged, 80 and overClostridioides difficileClostridium InfectionsCross InfectionDisease Transmission, InfectiousDNA, BacterialFemaleGenetic VariationGenome-Wide Association StudyHumansIncidenceMaleSequence Analysis, DNAUnited KingdomDNA, Bacterial

Identifiers

PMID24066741
PMCPMC3868928
OpenAlexW2149753281

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