Figure 1.

Countries* where Clostridium difficile PCR ribotype 027 has been reported

Sources of information include reports from the USA8, 34 and Canada,³⁵ reporting hospital outbreaks since 2001; the UK,29, 36 the Netherlands,37, 38, 39 Belgium,⁴⁰ and Ireland,⁴¹ reporting hospital outbreaks since 2005; France,28, 42 Switzerland,⁴³ and Luxembourg,⁴⁴ reporting hospital outbreaks since 2006; Germany,45, 46, 47 reporting hospital outbreaks since 2007; and Austria27, 48 and Denmark,44, 45, 49 reporting hospital outbreaks since 2008. Sporadic or imported cases of infection caused by C difficile PCR ribotype 027 have also been reported from Costa Rica,⁵⁰ Finland,51, 52 Hungary,45, 53 Italy,⁵⁴ Norway,⁵⁵ Poland,44, 45 Spain,⁴⁵ Sweden,⁵⁶ Western Australia,⁵⁷ South Korea,⁵⁸ and Hong Kong.⁵⁹ The earliest known isolate from the Netherlands was collected in 2002,³⁷ but—like earlier strains of PCR ribotype 027 in North America, isolates from Japan,60, 61 and the majority of recent isolates from Sweden56, 62—it was susceptible to fluoroquinolones and is thought a historic strain not associated with the recent international epidemic. *And states or provinces of the USA, Canada, and Australia.