Mechanisms of hypervirulent Clostridium difficile ribotype 027 displacement of endemic strains: An epidemiological model

Laith Yakob*, Thomas V. Riley, David L. Paterson, John Marquess, Ricardo J.Soares Magalhaes, Luis Furuya-Kanamori, Archie C.A. Clements

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    35 Citations (Scopus)

    Abstract

    Following rapid, global clonal dominance of hypervirulent ribotypes, Clostridium difficile now constitutes the primary infectious cause of nosocomial diarrhoea. Evidence indicates at least three possible mechanisms of hypervirulence that facilitates the successful invasion of these atypical strains: 1) increased infectiousness relative to endemic strains; 2) increased symptomatic disease rate relative to endemic strains; and 3) an ability to outcompete endemic strains in the host's gut. Stochastic simulations of an infection transmission model demonstrate clear differences between the invasion potentials of C. difficile strains utilising the alternative hypervirulence mechanisms, and provide new evidence that favours certain mechanisms (1 and 2) more than others (3). Additionally, simulations illustrate that direct competition between strains (inside the host's gut) is not a prerequisite for the sudden switching that has been observed in prevailing ribotypes; previously dominant C. difficile strains can be excluded by hypervirulent ribotypes through indirect (exploitative) competition.

    Original languageEnglish
    Article number12666
    JournalScientific Reports
    Volume5
    DOIs
    Publication statusPublished - 28 Jul 2015

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