Table 1.
WGS-based studies of C. difficile transmissions, outbreaks, or recurrences.
| References | Aim | Country | Description |
|---|---|---|---|
| Didelot et al. (9) | Transmission | UK | Microevolutionary analysis of C. difficile (assessment of within-host evolutionary rate) and use of whole-genome sequencing for studying C. difficile transmission. |
| Eyre et al. (20) | Transmission | UK | A proof-of-principle study to investigate potentials of benchtop sequencers in routine clinical practice to investigate transmissions. Example of small cluster of genetically (MLST) identical C. difficile strains that could be differentiated with WGS. |
| Eyre et al. (10) | Transmission | UK | Investigating the role of symptomatic patients in the transmission of C. difficile. Study also demonstrates that in the settings with standard infection control most cases of infections are acquired from other sources, not symptomatic cases. |
| Eyre et al. (21) | Mixed infections | UK | Describing new algorithm for detection of mixed CDI in clinical samples from whole genome sequencing data. |
| Eyre et al. (22) | Transmission | UK | Investigating the role of asymptomatic patients in the transmission of C. difficile. |
| Eyre et al. (23) | Recurrence | UK | Use of WGS to determine if the reductions in recurrence of CDI observed with fidaxomicin occurred by preventing relapse, reinfection or both. Study demonstrated that fidaxomicin was superior to vancomycin in treating recurrent CDI. |
| Mac Aoga'in et al. (24) | Recurrence | Ireland | Use of WGS of C. difficile to discriminate between relapses and reinfections, and putative patient-patient transmission events in Ireland. |
| Kumar et al. (25) | Transmission | UK | A WGS to track the transmission of C. difficile PCR ribotype 027 within single hospital in UK, and to distinguish between the relapses and reinfections. |
| Sim et al. (26) | Recurrence | USA | Use of WGS to determine the rate of relapse and reinfection in patients with recurrent CDI. |
| Mawer et al. (27) | Transmission | UK | Exploring the role of symptomatic patients that are toxigenic strain positive but fecal toxin negative in transmissions of C. difficile. |
| Eyre et al. (28) | Transmission | UK | Use of WGS as surveillance tool to assess infection control effectiveness in hospitals by identifying the extent of hospital-acquired CDI transmissions within hospitals. |
| Stoesser et al. (29) | Transmission | UK | Investigation of genetic overlap of infant and regional C. difficile strains in Oxfordshire. |
| Donskey et al. (30) | Transmission | USA | Transmission of C. difficile from colonized or infected long-term care facility residents. |
| Endres et al. (31) | Outbreak | USA | Environmental transmission of C. difficile PCR ribotype 027 at a long-term care facility. |
| Eyre et al. (32) | Transmission | UK | WGS to analyze distinct patterns of C. difficile PCR ribotype spread across Europe. |
| Halstead et al. (33) | Transmission | UK | WGS to investigate if asymptomatic carriers contribute to nosocomial CDI. |
| Isidro et al. (34) | Outbreak | Portugal | Genomic investigation of C. difficile PCR ribotype 017 outbreak strains. |
| Kociolek et al. (35) | Transmission | USA | Transmission of CDI among symptomatic children. |
| Kong et al. (36) | Transmission | Canada | Investigation of transmission patterns between infected and colonized patients. |
| Williamson et al. (37) | Transmission | USA | Transmission of PCR ribotype 027 within healthcare facility and comparison to global collection of ribotype 027 isolates. |
| García-Fernández et al. (38) | Transmission | Spain | Routes and frequencies of transmission of C. difficile in a tertiary-care hospital in Madrid. |