Application of multiple-locus variable-number tandem-repeat analysis to determine clonal spread of toxin A-negative Clostridium difficile in a general.

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Application of multiple-locus variable-number tandem-repeat analysis to determine clonal spread of toxin A-negative Clostridium difficile in a general hospital in Buenos Aires, Argentina A. Goorhuis, M.C. Legaria, R.J. van den Berg, C. Harmanus, C.H.W. Klaassen, J.S. Brazier, G. Lumelsky, E.J. Kuijper Clinical Microbiology and Infection Volume 15, Issue 12, Pages 1080-1086 (December 2009) DOI: 10.1111/j.1469-0691.2009.02759.x Copyright © 2009 European Society of Clinical Infectious Diseases Terms and Conditions

FIG. 1 Minimum spanning tree analysis of 71 Clostridium difficile isolates typed by multiple-locus variable-number tandem-repeat analysis (MLVA), including 56 Argentinean isolates (Ar) and 15 isolates from other countries. Isolates are labelled by country plus a number. Unique isolates or isolates with completely identical MLVA types are shown within a dark grey, light grey or white circle. The numbers between the circles represent the summed tandem repeat differences (STRDs) between MLVA types. All isolates in dark grey circles represent a large genetically related cluster, defined by an STRD ≤ 10. Within the light grey cluster, five boxed clonal complexes (CC-A to CC-E) are defined by an STRD ≤ 2. Isolates in light grey circles are genetically related clusters (clusters I and II in dashed boxes) or clonal complexes (CC-1 and CC-2) that do not belong to the large dark grey cluster. The white circles represent isolates that are not related to light or dark grey isolates. Ned, the Netherlands; Pol, Poland; Jap, Japan; US, USA; Fr, France; Can, Canada. Clinical Microbiology and Infection 2009 15, 1080-1086DOI: (10.1111/j.1469-0691.2009.02759.x) Copyright © 2009 European Society of Clinical Infectious Diseases Terms and Conditions

FIG. 2 Minimum spanning tree of 56 Argentinean isolates, derived from Fig. 1, by ward and year. Isolates are labelled by department and the last two digits of the year of isolation. Unique isolates or isolates with completely identical multiple-locus variable-number tandem-repeat analysis (MLVA) types are shown within dark grey, light grey or white circles. The numbers between the circles represent the summed tandem repeat differences (STRDs) between MLVA types. All isolates in dark grey circles represent a large genetically related cluster, defined by an STRD ≤ 10. Within the dark grey cluster, four boxed clonal complexes (CC-A to CC-D) are defined by an STRD ≤ 2. Isolates in light grey circles are a genetically related cluster (cluster I in a dashed box) and a clonal complex (CC-1) that do not belong to the large dark grey cluster. The white circles represent isolates that are not related to light or dark grey isolates. IM, internal medicine; Pul, pulmonology; ICU, intensive care unit; Sur, surgery; MC, medium care; EM, emergency medicine. Clinical Microbiology and Infection 2009 15, 1080-1086DOI: (10.1111/j.1469-0691.2009.02759.x) Copyright © 2009 European Society of Clinical Infectious Diseases Terms and Conditions