Clostridium difficile: Investigating Transmission Patterns Between Symptomatic and Asymptomatic Patients Using Whole Genome Sequencing
Notice bibliographique
Résumé
Abstract Background Patients with symptomatic Clostridium difficile infection (CDI) are thought to be responsible for most transmission events, but whole genome sequencing (WGS) studies have raised interest in asymptomatic carriers’ role in transmission. Methods Patients with CDI and colonization were identified using weekly screening in a study conducted during 2006–2007 at six Canadian hospitals. Isolates were typed using pulsed-field gel electrophoresis (PFGE), multi-locus sequence typing (MLST), and WGS. Toxigenic status was determined using cytotoxin testing and tcdB PCR. Incident CDI cases, not included in the initial study, were also sequenced where possible. Ward movement and typing data were combined to identify plausible donors for each CDI case, as defined by shared time and space on the same ward within predefined limits (infectious period <8 weeks and incubation period <12 weeks), or a shared ward after diagnosis of the donor within 26 weeks of the donor’s discharge. Proportions of plausible donors for CDI cases that were colonized, infected, or both were examined. Results A total of 554 samples were sequenced successfully, 348 from colonized, 201 from infected, and 5 from patients with unknown status. The NAP1/027/ST1 strain was most common among infected and colonized patients. Colonized patients predominantly carried toxigenic strains. Comparing samples from infected patients with all prior samples, a donor with a plausible ward link was found for 115 (57.2%) cases using PFGE, 127 (63.2%) using MLST, and 81 (40.3%) using WGS with a threshold of ≤2 single-nucleotide variants to determine relatedness. Examining data from the two hospitals with most complete data, across all typing methods, more cases could be linked to infected patients rather than to colonized patients. Using WGS, 26 (21.9%) cases were genetically linked to infected patients only, whereas 4 (3.4%) to colonized patients only, and 30 (25.2%) to both. Of those with a genetic link to an infected patient, 21 (17.7%) had a ward link, whereas this was found for only 1 (0.8%) case linked to a colonized patient. Conclusion Asymptomatic carriers contribute to transmission, but CDI cases are more likely linked to other infected patients than colonized patients in this cohort with high rates of NAP1/027/ST1 strain. Disclosures M. Wilcox, Merck & Co., Inc.: Consultant, Consulting fee. Cubist: Consultant, Grant Investigator and Speaker’s Bureau, Consulting fee, Grant recipient and Speaker honorarium. Alere, Actelion Pharma, Astellas, Optimer, Sanofi pasteur, Summit Pharma, bioMerieux, Da Volterra, Qiagen, Cerexa, Abbott, AstraZeneca, Pfizer, Durata Therapeutics, Seres Therapeutics, Valneva, Nabriva Therapeutics, Roche, The Medicines Company, Basilea P: Consultant, Consulting fee. Alere, Actelion Pharmaceuticals, Pharmaceuticals, Astellas, Optimer Pharmaceuticals, Sanofi pasteur, Summit Pharmaceuticals, bioMerieux, Da Volterra, Qiagen, Cerexa, and Abbott: Grant Investigator, Grant recipient.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,002 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».