{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T23:01:06Z","timestamp":1792105266624,"version":"4.4.0"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2020,4,15]],"date-time":"2020-04-15T00:00:00Z","timestamp":1586908800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Health Sciences Centre Winnipeg"},{"DOI":"10.13039\/100010318","name":"University of Manitoba","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010318","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Microbiology Laboratory \u2013 Public Health Agency of Canada and Merck & Co. Inc"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To summarize data generated by the Canadian Clostridioides difficile (CAN-DIFF) surveillance study from 2013 to 2017.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Isolates of C. difficile (n\u2009=\u20092158) were cultured from toxin-positive diarrhoeal stool specimens submitted by eight hospital laboratories to a coordinating laboratory. Antimicrobial susceptibility testing was performed according to the CLSI agar dilution method (M11, 2018). Isolate ribotypes were determined using an international, standardized, high-resolution capillary gel-based electrophoresis protocol.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of the 2158 isolates of C. difficile, 2133 (98.8%) had vancomycin MICs \u22642\u2009mg\/L [i.e. were vancomycin susceptible (EUCAST breakpoint tables, v 9.0, 2019) or WT (CLSI M100, 29th edition, 2019)]. Fidaxomicin MICs were lower than those of all other agents tested (MIC90, 0.5\u2009mg\/L); however, one isolate with a fidaxomicin MIC of &amp;gt;8\u2009mg\/L was identified. Metronidazole MICs ranged from 0.12 to 4\u2009mg\/L; all isolates were metronidazole susceptible by the CLSI breakpoint (\u22648\u2009mg\/L) compared with 96.8% susceptible by the EUCAST breakpoint (\u22642\u2009mg\/L). In total, 182 different ribotypes were identified from 2013 to 2017. The most common ribotypes identified were 027 (19.3% of isolates) and 106 (8.2%). Ribotype 027 isolates were frequently moxifloxacin resistant (87.3% of isolates) and MDR (48.6%), associated with vancomycin (10\/25, 40.0%) and metronidazole (58\/69, 84.1%) resistance and from patients aged \u226580\u2009years. The prevalence of ribotype 027 decreased significantly (P\u2009&amp;lt;\u20090.0001) from 2013 (27.5%) to 2017 (9.0%) and was replaced by increases in ribotype 106 (P\u2009=\u20090.0003) and multiple less common ribotypes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Periodic surveillance is required to monitor clinical isolates of C. difficile for changes to in vitro susceptibility testing profiles and ribotype evolution.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jac\/dkaa118","type":"journal-article","created":{"date-parts":[[2020,3,6]],"date-time":"2020-03-06T20:21:11Z","timestamp":1583526071000},"page":"1824-1832","source":"Crossref","is-referenced-by-count":20,"title":["Antimicrobial susceptibility of Clostridioides difficile isolated from diarrhoeal stool specimens of Canadian patients: summary of results from the Canadian Clostridioides difficile (CAN-DIFF) surveillance study from 2013 to 2017"],"prefix":"10.1093","volume":"75","author":[{"given":"James A","family":"Karlowsky","sequence":"first","affiliation":[{"name":"Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada"},{"name":"Shared Health Manitoba, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather J","family":"Adam","sequence":"first","affiliation":[{"name":"Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada"},{"name":"Shared Health Manitoba, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie R","family":"Baxter","sequence":"first","affiliation":[{"name":"Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher W","family":"Dutka","sequence":"first","affiliation":[{"name":"Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim A","family":"Nichol","sequence":"first","affiliation":[{"name":"Shared Health Manitoba, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy M","family":"Laing","sequence":"first","affiliation":[{"name":"Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George R","family":"Golding","sequence":"first","affiliation":[{"name":"Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada"},{"name":"National Microbiology Laboratory \u2013 Public Health Agency of Canada, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George G","family":"Zhanel","sequence":"first","affiliation":[{"name":"Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,4,15]]},"reference":[{"key":"2020061904535314100_dkaa118-B1","doi-asserted-by":"crossref","first-page":"S12","DOI":"10.1086\/521863","article-title":"Clinical recognition and diagnosis of Clostridium difficile infection","volume":"46","author":"Bartlett","year":"2008","journal-title":"Clin Infect Dis"},{"key":"2020061904535314100_dkaa118-B2","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1017\/ice.2019.178","article-title":"Attributable costs and length of stay of hospital-acquired Clostridioides difficile: a population-based matched cohort study in Alberta, Canada","volume":"40","author":"Leal","year":"2019","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2020061904535314100_dkaa118-B3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/1469-0691.12418","article-title":"European Society of Clinical Microbiology and Infectious Diseases: update of the treatment guidance document for Clostridium difficile infection","volume":"20 Suppl 2","author":"Debast","year":"2014","journal-title":"Clin Microbiol Infect"},{"key":"2020061904535314100_dkaa118-B4","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1093\/cid\/ciy149","article-title":"Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA)","volume":"66","author":"McDonald","year":"2018","journal-title":"Clin Infect Dis"},{"key":"2020061904535314100_dkaa118-B5","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/S1473-3099(11)70374-7","article-title":"Fidaxomicin versus vancomycin for infection with Clostridium difficile in Europe, Canada, and the USA: a double-blind, non-inferiority, randomised controlled trial","volume":"12","author":"Cornely","year":"2012","journal-title":"Lancet Infect Dis"},{"key":"2020061904535314100_dkaa118-B6","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1099\/jmm.0.000580","article-title":"Fidaxomicin reduces early toxin A and toxin B production and sporulation in Clostridium difficile in vitro","volume":"66","author":"Aldape","year":"2017","journal-title":"J Med Microbiol"},{"key":"2020061904535314100_dkaa118-B7","doi-asserted-by":"crossref","first-page":"1586","DOI":"10.1086\/430311","article-title":"Relatively poor outcome after treatment of Clostridium difficile colitis with metronidazole","volume":"40","author":"Musher","year":"2005","journal-title":"Clin Infect Dis"},{"key":"2020061904535314100_dkaa118-B8","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1128\/CMR.00082-09","article-title":"The changing epidemiology of Clostridium difficile infections","volume":"23","author":"Freeman","year":"2010","journal-title":"Clin Microbiol Rev"},{"key":"2020061904535314100_dkaa118-B9","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1093\/cid\/cis430","article-title":"Decreased cure and increased recurrence rates for Clostridium difficile infection caused by epidemic C. difficile BI strain","volume":"55","author":"Petrella","year":"2012","journal-title":"Clin Infect Dis"},{"key":"2020061904535314100_dkaa118-B10","doi-asserted-by":"crossref","first-page":"E758","DOI":"10.1503\/cmaj.180013","article-title":"The evolving epidemiology of Clostridium difficile infection in Canadian hospitals during a postepidemic period (2009-2015","volume":"190","author":"Katz","year":"2018","journal-title":"CMAJ"},{"key":"2020061904535314100_dkaa118-B11","doi-asserted-by":"crossref","first-page":"S32","DOI":"10.1086\/655998","article-title":"Global epidemiology of Clostridium difficile infection in 2010","volume":"31 Suppl 1","author":"Gerding","year":"2010","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2020061904535314100_dkaa118-B12","doi-asserted-by":"crossref","first-page":"2433","DOI":"10.1056\/NEJMoa051590","article-title":"An epidemic, toxin gene-variant strain of Clostridium difficile","volume":"353","author":"McDonald","year":"2005","journal-title":"N Engl J Med"},{"key":"2020061904535314100_dkaa118-B13","doi-asserted-by":"crossref","first-page":"e00391","DOI":"10.1128\/AAC.00391-19","article-title":"U.S.-based national surveillance for fidaxomicin susceptibility of Clostridioides difficile-associated diarrheal isolates from 2013 to 2016","volume":"63","author":"Thorpe","year":"2019","journal-title":"Antimicrob Agents Chemother"},{"key":"2020061904535314100_dkaa118-B14","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.anaerobe.2018.05.009","article-title":"Molecular epidemiology of Clostridioides (Clostridium) difficile strains recovered from clinical trials in the US, Canada and Europe from 2006-2009 to 2012-2015","volume":"53","author":"Cheknis","year":"2018","journal-title":"Anaerobe"},{"key":"2020061904535314100_dkaa118-B15","doi-asserted-by":"crossref","first-page":"102050","DOI":"10.1016\/j.anaerobe.2019.06.003","article-title":"Changes in molecular epidemiology and antimicrobial resistance profiles of Clostridioides difficile strains in the United States between 2011 and 2017","volume":"60","author":"Tickler","year":"2019","journal-title":"Anaerobe"},{"key":"2020061904535314100_dkaa118-B16","doi-asserted-by":"crossref","first-page":"8207418","DOI":"10.1155\/2016\/8207418","article-title":"Characterization of Clostridium difficile strains in British Columbia, Canada: a shift from NAP1 majority (2008) to novel strain types (2013) in one region","volume":"2016","author":"Jassem","year":"2016","journal-title":"Can J Infect Dis Med Microbiol"},{"key":"2020061904535314100_dkaa118-B17","year":"2008","edition":"Second Edition"},{"key":"2020061904535314100_dkaa118-B18","doi-asserted-by":"crossref","first-page":"2178","DOI":"10.1128\/JCM.36.8.2178-2182.1998","article-title":"Identification of toxin A-negative, toxin B-positive Clostridium difficile by PCR","volume":"36","author":"Kato","year":"1998","journal-title":"J Clin Microbiol"},{"key":"2020061904535314100_dkaa118-B19","doi-asserted-by":"crossref","first-page":"5710","DOI":"10.1128\/JCM.42.12.5710-5714.2004","article-title":"Multiplex PCR targeting tpi (triose phosphate isomerase), tcdA (toxin A), and tcdB (toxin B) genes for toxigenic culture of Clostridium difficile","volume":"42","author":"Lemee","year":"2004","journal-title":"J Clin Microbiol"},{"key":"2020061904535314100_dkaa118-B20","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1111\/j.1574-6968.2000.tb09122.x","article-title":"Production of actin-specific ADP-ribosyltransferase (binary toxin) by strains of Clostridium difficile","volume":"186","author":"Stubbs","year":"2000","journal-title":"FEMS Microbiol Lett"},{"key":"2020061904535314100_dkaa118-B21","doi-asserted-by":"crossref","first-page":"e0118150","DOI":"10.1371\/journal.pone.0118150","article-title":"Development and validation of an internationally-standardized, high-resolution capillary gel-based electrophoresis PCR-ribotyping protocol for Clostridium difficile","volume":"10","author":"Fawley","year":"2015","journal-title":"PLoS One"},{"key":"2020061904535314100_dkaa118-B22","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.diagmicrobio.2018.01.017","article-title":"PCR ribotyping and antimicrobial susceptibility testing of isolates of Clostridium difficile cultured from toxin-positive diarrheal stools of patients receiving medical care in Canadian hospitals: the Canadian Clostridium difficile surveillance study (CAN-DIFF) 2013-2015","volume":"91","author":"Karlowsky","year":"2018","journal-title":"Diagn Microbiol Infect Dis"},{"key":"2020061904535314100_dkaa118-B23","year":"2018"},{"key":"2020061904535314100_dkaa118-B24","year":"2019"},{"key":"2020061904535314100_dkaa118-B25","year":"2019"},{"key":"2020061904535314100_dkaa118-B26","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.1093\/cid\/cis614","article-title":"Changing epidemiology of Clostridium difficile infection following the introduction of a national ribotyping-based surveillance scheme in England","volume":"55","author":"Wilcox","year":"2012","journal-title":"Clin Infect Dis"},{"key":"2020061904535314100_dkaa118-B27","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.anaerobe.2019.102072","article-title":"Increasing antibiotic resistance in Clostridioides difficile: a systematic review and meta-analysis","volume":"58","author":"Saha","year":"2019","journal-title":"Anaerobe"},{"key":"2020061904535314100_dkaa118-B28","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1093\/jac\/dkn313","article-title":"Emergence of reduced susceptibility to metronidazole in Clostridium difficile","volume":"62","author":"Baines","year":"2008","journal-title":"J Antimicrob Chemother"},{"key":"2020061904535314100_dkaa118-B29","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.anaerobe.2009.09.005","article-title":"Typing and susceptibility of bacterial isolates from the fidaxomicin (OPT-80) phase II study for C. difficile infection","volume":"15","author":"Citron","year":"2009","journal-title":"Anaerobe"},{"key":"2020061904535314100_dkaa118-B30","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.1007\/s40265-013-0134-z","article-title":"Fidaxomicin: a review of its use in patients with Clostridium difficile infection","volume":"73","author":"Scott","year":"2013","journal-title":"Drugs"},{"key":"2020061904535314100_dkaa118-B31","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1093\/jac\/dky375","article-title":"Characterization of a clinical Clostridioides difficile isolate with markedly reduced fidaxomicin susceptibility and a V1143D mutation in rpoB","volume":"74","author":"Schwanbeck","year":"2019","journal-title":"J Antimicrob Chemother"},{"key":"2020061904535314100_dkaa118-B32","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1093\/jac\/dkx486","article-title":"Characterization of the impact of rpoB mutations on the in vitro and in vivo competitive fitness of Clostridium difficile and susceptibility to fidaxomicin","volume":"73","author":"Kuehne","year":"2018","journal-title":"J Antimicrob Chemother"},{"key":"2020061904535314100_dkaa118-B33","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1086\/649213","article-title":"Health care-associated Clostridium difficile infection in Canada: patient age and infecting strain type are highly predictive of severe outcome and mortality","volume":"50","author":"Miller","year":"2010","journal-title":"Clin Infect Dis"}],"container-title":["Journal of Antimicrobial Chemotherapy"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jac\/article-pdf\/75\/7\/1824\/33404948\/dkaa118.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jac\/article-pdf\/75\/7\/1824\/33404948\/dkaa118.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,6,19]],"date-time":"2020-06-19T08:54:47Z","timestamp":1592556887000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jac\/article\/75\/7\/1824\/5820582"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,4,15]]},"references-count":33,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2020,4,15]]},"published-print":{"date-parts":[[2020,7,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jac\/dkaa118","relation":{},"ISSN":["0305-7453","1460-2091"],"issn-type":[{"value":"0305-7453","type":"print"},{"value":"1460-2091","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,7]]},"published":{"date-parts":[[2020,4,15]]}}}