Molecular evolution of Clostridium difficile ribotype 078 in Scotland: combining genomic analysis with health informatics

Clostridium difficile infection (CDI) is the most common cause of antibiotic-associated diarrhoea and healthcare-associated infection in the developed world. It often presents in large outbreaks characteristically occurring in elderly patients, frequently following a course of antibiotics, and poses a significant risk to health. Specific strain types are associated with severe disease, however, the prevalence of some types are changing and may be associated with greater transmission between the community and healthcare environment. This project focuses on analysing the entire DNA content of isolates of the type of C. difficile that is recovered most frequently in hospitals across Scotland, ‘ribotype 078’. The aim of the project is to consider how this particular strain has evolved over time and geographical location. The influence of resistance to antibiotics and the acquisition of specific virulence genes associated with the disease process will be considered. Linking this information to healthcare informatics I aim to establish the most frequent source (community or hospital) of this infection and determine the circumstances most frequently associated with disease. The project will involve the generation of a huge amount of data which, through linkage with healthcare informatics, aims provide an important resource in management of this disease in Scotland.