Epidemic Clostridioides difficile Ribotype 027 Lineages: Comparisons of Texas Versus Worldwide Strains

dc.contributor.authorEndres, Bradley T.
dc.contributor.authorBegum, Khurshida
dc.contributor.authorSun, Hua
dc.contributor.authorWalk, Seth T.
dc.contributor.authorMemariani, Ali
dc.contributor.authorLancaster, Chris
dc.contributor.authorGonzales-Luna, Anne J.
dc.contributor.authorDotson, Kierra M.
dc.contributor.authorBassères, Eugénie
dc.contributor.authorOffiong, Charlene
dc.contributor.authorTupy, Shawn
dc.contributor.authorKuper, Kristi
dc.contributor.authorSeptimus, Edward
dc.contributor.authorArafat, Raouf
dc.contributor.authorAlam, M. Jahangir
dc.contributor.authorZhao, Zhongming
dc.contributor.authorHurdle, Julian G.
dc.contributor.authorSavidge, Tor C.
dc.contributor.authorGarey, Kevin W.
dc.description.abstractBackground The epidemic Clostridioides difficile ribotype 027 strain resulted from the dissemination of 2 separate fluoroquinolone-resistant lineages: FQR1 and FQR2. Both lineages were reported to originate in North America; however, confirmatory large-scale investigations of C difficile ribotype 027 epidemiology using whole genome sequencing has not been undertaken in the United States. Methods Whole genome sequencing and single-nucleotide polymorphism (SNP) analysis was performed on 76 clinical ribotype 027 isolates obtained from hospitalized patients in Texas with C difficile infection and compared with 32 previously sequenced worldwide strains. Maximum-likelihood phylogeny based on a set of core genome SNPs was used to construct phylogenetic trees investigating strain macro- and microevolution. Bayesian phylogenetic and phylogeographic analyses were used to incorporate temporal and geographic variables with the SNP strain analysis. Results Whole genome sequence analysis identified 2841 SNPs including 900 nonsynonymous mutations, 1404 synonymous substitutions, and 537 intergenic changes. Phylogenetic analysis separated the strains into 2 prominent groups, which grossly differed by 28 SNPs: the FQR1 and FQR2 lineages. Five isolates were identified as pre-epidemic strains. Phylogeny demonstrated unique clustering and resistance genes in Texas strains indicating that spatiotemporal bias has defined the microevolution of ribotype 027 genetics. Conclusions Clostridioides difficile ribotype 027 lineages emerged earlier than previously reported, coinciding with increased use of fluoroquinolones. Both FQR1 and FQR2 ribotype 027 epidemic lineages are present in Texas, but they have evolved geographically to represent region-specific public health threats.en_US
dc.description.sponsorshipNational Institutes of Health National Institute of Allergy and Infectious Diseases (U01AI124290-01 and 1R56AI126881-01A1); Centers for Disease Control and Prevention (CDC-RFA-CK17-1701)en_US
dc.identifier.citationEndres, Bradley T., Khurshida Begum, Hua Sun, Seth T. Walk, Ali Memariani, Chris Lancaster, Anne J. Gonzales-Luna, Kierra M. Dotson, Eugénie Bassères, Charlene Offiong, Shawn Tupy, Kristi Kuper, Edward Septimus, Raouf Arafat, M. Jahangir Alam, Zhongming Zhao, Julian G. Hurdle, Tor C. Savidge, and Kevin W. Garey. "Epidemic Clostridioides difficile Ribotype 027 Lineages: Comparisons of Texas Versus Worldwide Strains." Open forum infectious diseases 6, no. 2 (February 2019). DOI:10.1093/ofid/ofz013.en_US
dc.rightsCC BY: This license lets you distribute, remix, tweak, and build upon this work, even commercially, as long as you credit the original creator for this work. This is the most accommodating of licenses offered. Recommended for maximum dissemination and use of licensed materials.en_US
dc.titleEpidemic Clostridioides difficile Ribotype 027 Lineages: Comparisons of Texas Versus Worldwide Strainsen_US
mus.citation.journaltitleOpen Forum Infectious Diseasesen_US
mus.identifier.categoryHealth & Medical Sciencesen_US
mus.relation.collegeCollege of Letters & Scienceen_US
mus.relation.departmentMicrobiology & Immunology.en_US
mus.relation.universityMontana State University - Bozemanen_US


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