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Background .  Clostridium difficile  is a major cause of gastrointestinal illness. Epidemic NAP1 strains contain toxins A and B, a deletion in repressor  tcdC , and a binary toxin.  Objectives . To determine the molecular epidemiology of  C. difficile  in British Columbia and compare between two time points in one region.  Methods .  C. difficile  isolates from hospital and community laboratories (2008) and one Island Health hospital laboratory (2013) were characterized by pulsed-field gel electrophoresis, PCR-ribotyping, toxin possession,  tcdC  genotype, and antimicrobial susceptibility.  Results . In 2008, 42.7% of isolates had NAP1 designation. Hospital-collected isolates were associated with older patients and more NAP1 types. Unlike other isolates, most NAP1 isolates possessed binary toxin and a 19 bp loss in  tcdC . All isolates were susceptible to metronidazole and vancomycin. A 2013 follow-up revealed a 28.9% decrease in NAP1 isolates and 20.0% increase in isolates without NAP designation in one region. Then, community-associated cases were seen in younger patients, while NAP types were evenly distributed. Isolates without NAP designation did not cluster with a PFGE pattern or ribotype.  Conclusions . Evaluation of  C. difficile  infections within British Columbia revealed demographic associations, epidemiological shifts, and characteristics of strain types. Continuous surveillance of  C. difficile  will enable detection of emerging strains.

the canadian journal of infectious diseases and medical microbiology/canadian journal of infectious diseases and medical microbiology

Characterization of<i>Clostridium difficile</i>Strains in British Columbia, Canada: A Shift from NAP1 Majority (2008) to Novel Strain Types (2013) in One Region

Characterization ofClostridium difficileStrains in British Columbia, Canada: A Shift from NAP1 Majority (2008) to Novel Strain Types (2013) in One Region