ArticleInfection and immunity2014
Epidemic Clostridium difficile strains demonstrate increased competitive fitness compared to nonepidemic isolates.
Article in Infection and immunity, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 44 papers.
What it found
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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.
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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.
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Who cites it
44 citing papers in PubMed.
- Article
- Strengths and limitations ofGut microbes reports · 2026Review
- An In Vitro Model for Studying Interactions Between Gastrointestinal Microbes and Planktonic and Sessile Clostridioides difficile Populations.Methods in molecular biology (Clifton, N.J.) · 2026Article
- Evaluating Effects of Antibiotics Across Preclinical Models of the Human Gastrointestinal Microbiota.MicrobiologyOpen · 2025Article
- A thiouracil desulfurase protects Clostridioides difficile RNA from 4-thiouracil incorporation, providing a competitive advantage in the gut.Cell host & microbe · 2025Article
- Review
- Article
- Review
- Clostridioides difficile Biofilm.Advances in experimental medicine and biology · 2024Article
- Multi-omics analysis of hospital-acquired diarrhoeal patients reveals biomarkers of enterococcal proliferation and Clostridioides difficile infection.Nature communications · 2023Article
- Bacillus velezensis DSM 33864 reduces Clostridioides difficile colonization without disturbing commensal gut microbiota composition.Scientific reports · 2023Article
- Screening, Identification and Physiological Characteristics ofFoods (Basel, Switzerland) · 2023Article
- MBRA-2: a Modified Chemostat System to Culture Biofilms.Microbiology spectrum · 2023Article
- Microbiota Transplantation in Day-Old Broiler Chickens Ameliorates Necrotic Enteritis via Modulation of the Intestinal Microbiota and Host Immune Responses.Pathogens (Basel, Switzerland) · 2022Article
- MiniBioReactor Array (MBRA)JAC-antimicrobial resistance · 2022Article
- Children gut microbiota exhibits a different composition and metabolic profile afterFrontiers in microbiology · 2022Article
- Integrating Systems and Synthetic Biology to Understand and Engineer Microbiomes.Annual review of biomedical engineering · 2021Review
- Temporal Variations in Patterns ofAntibiotics (Basel, Switzerland) · 2021Article
- Mucin-Degrading Microbes Release Monosaccharides That ChemoattractACS infectious diseases · 2021Article
- Fusobacteriumnucleatum Adheres to Clostridioides difficile via the RadD Adhesin to Enhance Biofilm Formation in Intestinal Mucus.Gastroenterology · 2021Article
Corrections and comments
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Authors and funding
4 authors.
Funding
Abstract
Clostridium difficile infection is the most common cause of severe cases of antibiotic-associated diarrhea (AAD) and is a significant health burden. Recent increases in the rate of C. difficile infection have paralleled the emergence of a specific phylogenetic clade of C. difficile strains (ribotype 027; North American pulsed-field electrophoresis 1 [NAP1]; restriction endonuclease analysis [REA] group BI). Initial reports indicated that ribotype 027 strains were associated with increased morbidity and mortality and might be hypervirulent. Although subsequent work has raised some doubt as to whether ribotype 027 strains are hypervirulent, the strains are considered epidemic isolates that have caused severe outbreaks across the globe. We hypothesized that one factor that could lead to the increased prevalence of ribotype 027 strains would be if these strains had increased competitive fitness compared to strains of other ribotypes. We developed a moderate-throughput in vitro model of C. difficile infection and used it to test competition between four ribotype 027 clinical isolates and clinical isolates of four other ribotypes (001, 002, 014, and 053). We found that ribotype 027 strains outcompeted the strains of other ribotypes. A similar competitive advantage was observed when two ribotype pairs were competed in a mouse model of C. difficile infection. Based upon these results, we conclude that one possible mechanism through which ribotype 027 strains have caused outbreaks worldwide is their increased ability to compete in the presence of a complex microbiota.
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