Observational studyClinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases2020
The recent emergence of a highly related virulent Clostridium difficile clade with unique characteristics.
Observational study in Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 41 papers.
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.
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.
Who cites it
41 citing papers in PubMed, 58 citations in OpenAlex.
- From colonization to infection: Genomic evolution of Clostridioides difficile pathogenesis.Cell reports · 2026Review
- Acquisition of a gene cluster inmSphere · 2026Article
- Article
- History and Evolution of the HypervirulentMicroorganisms · 2025Review
- Phenotypic analysis of variousApplied and environmental microbiology · 2025Article
- Whole genome sequence analysis reveals limited diversity among Clostridioides difficile ribotype 027 and 078 isolates collected in 22 hospitals in Berlin and Brandenburg, Germany.Antimicrobial resistance and infection control · 2025Article
- Unique growth and morphology properties of Clade 5bioRxiv : the preprint server for biology · 2025Article
- Community-AcquiredInternational journal of molecular sciences · 2025Review
- Unique growth and morphology properties of Clade 5 Clostridioides difficile strains revealed by single-cell time-lapse microscopy.PLoS pathogens · 2025Article
- The Global Burden ofInfectious disease reports · 2025Review
- EmergingmSystems · 2025Article
- Phenotypic analysis of variousbioRxiv : the preprint server for biology · 2025Article
- Distribution ofEmerging microbes & infections · 2024Article
- Comparative genomics of zoonotic pathogen3 Biotech · 2024Article
- EmergingbioRxiv : the preprint server for biology · 2024Article
- A case of community-acquired Clostridioides difficile infection causing intussusception, severe pneumonia, and severe hypokalemia.BMC infectious diseases · 2024Article
- A Severe Infection Caused by a White Colony-Producing Strain ofAnnals of laboratory medicine · 2024Article
- The Strain and the Clinical Outcome ofOpen forum infectious diseases · 2024Article
- Review
- Antibiotic Resistances of Clostridioides difficile.Advances in experimental medicine and biology · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
17 authors at 9 institutions in 4 countries.
Funding
Abstract
objectivesClostridium difficile is a major global human pathogen divided into five clades, of which clade 3 is the least characterized and consists predominantly of PCR ribotype (RT) 023 strains. Our aim was to analyse and characterize this clade.
methodsIn this cohort study the clinical presentation of C. difficile RT023 infections was analysed in comparison with known 'hypervirulent' and non-hypervirulent strains, using data from the Netherlands national C. difficile surveillance programme. European RT023 strains of diverse origin were collected and whole-genome sequenced to determine the genetic similarity between isolates. Distinctive features were investigated and characterized.
resultsClinical presentation of C. difficile RT023 infections show severe infections akin to those seen with 'hypervirulent' strains from clades 2 (RT027) and 5 (RT078) (35%, 29% and 27% severe CDI, respectively), particularly with significantly more bloody diarrhoea than RT078 and non-hypervirulent strains (RT023 8%, other RTs 4%, p 0.036). The full genome sequence of strain CD305 is presented as a robust reference. Phylogenetic comparison of CD305 and a further 79 previously uncharacterized European RT023 strains of diverse origin revealed minor genetic divergence with >99.8% pairwise identity between strains. Analyses revealed distinctive features among clade 3 strains, including conserved pathogenicity locus, binary toxin and phage insertion toxin genotypes, glycosylation of S-layer proteins, presence of the RT078 four-gene trehalose cluster and an esculinase-negative genotype.
conclusionsGiven their recent emergence, virulence and genomic characteristics, the surveillance of clade 3 strains should be more highly prioritized.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.