ArticleJournal of clinical microbiology2015
Emergence of an outbreak-associated Clostridium difficile variant with increased virulence.
Article in Journal of clinical microbiology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 1 of them a synthesis that pooled it.
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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.
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.
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Who cites it
32 citing papers in PubMed, 1 synthesis or guideline pooled it, 77 citations in OpenAlex.
- Electronic data collection, management and analysis tools used for outbreak response in low- and middle-income countries: a systematic review and stakeholder survey.BMC public health · 2021Pooled it
- The emergence and biological characteristics of linezolid-resistantEmerging microbes & infections · 2026Article
- The Global Burden ofInfectious disease reports · 2025Review
- Allele-linked divergence in SlpA and TcdB drives distinct immune and cytotoxic responses that distinguish ST01 from non-ST01 strains in Clade 2 Clostridioides difficile.Access microbiology · 2025Article
- Advances in diagnostic assays forFrontiers in cellular and infection microbiology · 2024Review
- Clostridioides Difficile in Latin America: An Epidemiological Overview.Current microbiology · 2023Review
- Factors Associated with Clostridioides (Clostridium) Difficile Infection and Colonization: Ongoing Prospective Cohort Study in a French University Hospital.International journal of environmental research and public health · 2021Observational
- MALDI-TOF MS: An alternative approach for ribotyping Clostridioides difficile isolates in Brazil.Anaerobe · 2021Article
- Gut Microbiota and Diarrhea: An Updated Review.Frontiers in cellular and infection microbiology · 2021Review
- In vivo animal models confirm an increased virulence potential and pathogenicity of the NAP1/RT027/ST01 genotype within theGut pathogens · 2020Article
- Mechanisms underpinning the efficacy of faecal microbiota transplantation in treating gastrointestinal disease.Therapeutic advances in gastroenterology · 2020Review
- Burden ofIranian journal of public health · 2019Review
- Toxin B Variants fromToxins · 2019Article
- The gut virome: the 'missing link' between gut bacteria and host immunity?Therapeutic advances in gastroenterology · 2019Review
- Colombia, an unknown genetic diversity in the era of Big Data.BMC genomics · 2018Article
- The evolving epidemiology ofCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2018Article
- Epidemiological aspects of healthcare-associated infections and microbial genomics.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2018Review
- Two Groups of Cocirculating, Epidemic Clostridiodes difficile Strains Microdiversify through Different Mechanisms.Genome biology and evolution · 2018Article
- Hypervirulent Clostridium difficile ribotypes are CpG depleted.Virulence · 2018Article
- The Novel Phages phiCD5763 and phiCD2955 Represent Two Groups of Big Plasmidial Siphoviridae Phages ofFrontiers in microbiology · 2018Article
Corrections and comments
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Authors and funding
15 authors at 5 institutions in 4 countries.
Funding
Abstract
The prevalence of Clostridium difficile infections has increased due to the emergence of epidemic variants from diverse genetic lineages. Here we describe the emergence of a novel variant during an outbreak in a Costa Rican hospital that was associated with severe clinical presentations. This C. difficile variant elicited higher white blood cell counts and caused disease in younger patients than did other strains isolated during the outbreak. Furthermore, it had a recurrence rate, a 30-day attributable disease rate, and disease severity as great as those of the epidemic strain NAP1. Pulsed-field gel electrophoresis genotyping indicated that the outbreak strains belong to a previously undescribed variant, designated NAPCR1. Whole-genome sequencing and ribotyping indicated that the NAPCR1 variant belongs to C. difficile ribotype 012 and sequence type 54, as does the reference strain 630. NAPCR1 strains are resistant to fluoroquinolones due to a mutation in gyrA, and they possess an 18-bp deletion in tcdC that is characteristic of the epidemic, evolutionarily distinct, C. difficile NAP1 variant. NAPCR1 genomes contain 10% more predicted genes than strain 630, most of which are of hypothetical function and are present on phages and other mobile genetic elements. The increased virulence of NAPCR1 was confirmed by mortality rates in the hamster model and strong inflammatory responses induced by bacteria-free supernatants in the murine ligated loop model. However, NAPCR1 strains do not synthesize toxin A and toxin B at levels comparable to those in NAP1 strains. Our results suggest that the pathogenic potential of this emerging C. difficile variant is due to the acquisition of hypothetical functions associated with laterally acquired DNA.
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