Summary: RESTRICTION FRAGMENT LENGTH POLYMORPHISM analysis of rRNA genes that is used for differentiating between species or strains.

Top Publications

  1. Cartman S, Heap J, Kuehne S, Cockayne A, Minton N. The emergence of 'hypervirulence' in Clostridium difficile. Int J Med Microbiol. 2010;300:387-95 pubmed publisher
    ..The identification of virulence factors using this approach should help lead to the rational development of therapeutic countermeasures against CDAD. ..
  2. Weese J, Reid Smith R, Avery B, Rousseau J. Detection and characterization of Clostridium difficile in retail chicken. Lett Appl Microbiol. 2010;50:362-5 pubmed publisher
    ..difficile infection. The relevance of food contamination is completely unclear at this point but food should be investigated as a source of infection. ..
  3. Avbersek J, Janezic S, Pate M, Rupnik M, Zidaric V, Logar K, et al. Diversity of Clostridium difficile in pigs and other animals in Slovenia. Anaerobe. 2009;15:252-5 pubmed publisher
    ..5%) calf samples, and 1/20 (5%) horse samples. The isolates were characterized by toxinotyping, PCR-ribotyping, and pulsed-field gel electrophoresis (PFGE) using restriction endonuclease SmaI...
  4. Ossiprandi M, Buttrini M, Bottarelli E, Zerbini L. Preliminary molecular analysis of Clostridium difficile isolates from healthy horses in northern Italy. Comp Immunol Microbiol Infect Dis. 2010;33:e25-9 pubmed publisher
    ..The aim of this study was to investigate by toxin gene profile and PCR-ribotyping the molecular characteristics of 14 C. difficile strains isolated from 42 faeces of healthy horses...
  5. Lancellotti M, Pace F, Stehling E, Villares M, Brocchi M, Silveira W. Ribotyping, biotyping and capsular typing of Haemophilus influenzae strains isolated from patients in Campinas, southeast Brazil. Braz J Infect Dis. 2008;12:430-7 pubmed
    ..types were determined by polymerase chain reaction (PCR); they were compared, using two molecular methods [ribotyping with a specific DNA probe amplified from the 16S rDNA region from H...
  6. Rea M, O Sullivan O, Shanahan F, O Toole P, Stanton C, Ross R, et al. Clostridium difficile carriage in elderly subjects and associated changes in the intestinal microbiota. J Clin Microbiol. 2012;50:867-75 pubmed publisher
    ..However, in contrast, a marked reduction in microbial diversity at genus level was observed in patients who had been diagnosed with CDAD at the time of sampling and from whom C. difficile R027 was isolated. ..
  7. Boone J, Goodykoontz M, Rhodes S, Price K, Smith J, Gearhart K, et al. Clostridium difficile prevalence rates in a large healthcare system stratified according to patient population, age, gender, and specimen consistency. Eur J Clin Microbiol Infect Dis. 2012;31:1551-9 pubmed publisher
    ..gender, and specimen consistency using bacterial culture, toxin detection, and polymerase chain reaction (PCR) ribotyping. Rates were determined based on the detection of toxigenic C. difficile isolates...
  8. Janezic S, Ocepek M, Zidaric V, Rupnik M. Clostridium difficile genotypes other than ribotype 078 that are prevalent among human, animal and environmental isolates. BMC Microbiol. 2012;12:48 pubmed publisher
    ..The genetic relatedness observed with PFGE suggests that transmission of given genotype from one reservoir to the other is likely to occur. ..
  9. Mulvey M, Boyd D, Gravel D, Hutchinson J, Kelly S, Mcgeer A, et al. Hypervirulent Clostridium difficile strains in hospitalized patients, Canada. Emerg Infect Dis. 2010;16:678-81 pubmed publisher
    ..Incidence of human infections increased from 0.5% in 2004/2005 to 1.6% in 2008. ..

More Information


  1. Walk S, Micic D, Jain R, Lo E, Trivedi I, Liu E, et al. Clostridium difficile ribotype does not predict severe infection. Clin Infect Dis. 2012;55:1661-8 pubmed publisher
    ..virulence factors by polymerase chain reaction (PCR) and ribotyped using high-throughput, fluorescent PCR ribotyping. We collected data for 15 covariates (microbiologic, epidemiologic, and laboratory variables) and determined ..
  2. Stewart D, Berg A, Hegarty J. Predicting recurrence of C. difficile colitis using bacterial virulence factors: binary toxin is the key. J Gastrointest Surg. 2013;17:118-24; discussion p.124-5 pubmed publisher
    ..3; 95 % CI, 3.52-6.09). Binary toxin gene is a predictor of recurrent infection. Its presence may require longer antibiotic regimens in an effort to lower already elevated recurrence rates. ..
  3. Cheknis A, Sambol S, Davidson D, Nagaro K, Mancini M, Hidalgo Arroyo G, et al. Distribution of Clostridium difficile strains from a North American, European and Australian trial of treatment for C. difficile infections: 2005-2007. Anaerobe. 2009;15:230-3 pubmed publisher
    ..pathogen with multiple strain types as determined by restriction endonuclease analysis (REA) and by PCR ribotyping, two well-characterized typing systems. In this study, REA typing was performed on 894C...
  4. Hargreaves K, Colvin H, Patel K, Clokie J, Clokie M. Genetically diverse Clostridium difficile strains harboring abundant prophages in an estuarine environment. Appl Environ Microbiol. 2013;79:6236-43 pubmed publisher
    ..Prophage carriage was found to be high (75%), demonstrating that phages play a role in the biology of these strains. ..
  5. Weese J, Avery B, Rousseau J, Reid Smith R. Detection and enumeration of Clostridium difficile spores in retail beef and pork. Appl Environ Microbiol. 2009;75:5009-11 pubmed publisher
    ..This study has identified relatively common contamination of retail ground beef and pork with C. difficile spores; however, the levels of contamination were very low. ..
  6. Biazzo M, Cioncada R, Fiaschi L, Tedde V, Spigaglia P, Mastrantonio P, et al. Diversity of cwp loci in clinical isolates of Clostridium difficile. J Med Microbiol. 2013;62:1444-52 pubmed publisher
    ..This is the first report on the distribution and variability of a number of genes encoding CWPs in C. difficile...
  7. Cheng V, Yam W, Chan J, To K, Ho P, Yuen K. Clostridium difficile ribotype 027 arrives in Hong Kong. Int J Antimicrob Agents. 2009;34:492-3 pubmed publisher
  8. Huang H, Weintraub A, Fang H, Nord C. Comparison of a commercial multiplex real-time PCR to the cell cytotoxicity neutralization assay for diagnosis of clostridium difficile infections. J Clin Microbiol. 2009;47:3729-31 pubmed publisher
    ..1% and 93.0% for fresh stools, using the cell cytotoxicity neutralization assay as the reference. Using PCR ribotyping as the reference for ribotype 027 strains, the corresponding figures were 100% and 98.1%, respectively.
  9. Goldenberg S, Gumban M, Hall A, Patel A, French G. Lack of effect of strain type on detection of toxigenic Clostridium difficile by glutamate dehydrogenase and polymerase chain reaction. Diagn Microbiol Infect Dis. 2011;70:417-9 pubmed publisher
    ..PCR was significantly more sensitive than GDH overall; however, there was no difference in detection according to specific ribotype. ..
  10. Manzoor S, Tanner H, Marriott C, Brazier J, Hardy K, Platt S, et al. Extended multilocus variable-number tandem-repeat analysis of Clostridium difficile correlates exactly with ribotyping and enables identification of hospital transmission. J Clin Microbiol. 2011;49:3523-30 pubmed publisher
    PCR ribotyping is currently used in many countries for epidemiological investigation to track transmission and to identify emerging variants of Clostridium difficile...
  11. Huang H, Weintraub A, Fang H, Wu S, Zhang Y, Nord C. Antimicrobial susceptibility and heteroresistance in Chinese Clostridium difficile strains. Anaerobe. 2010;16:633-5 pubmed publisher
    ..1%; gyrA mutation, 63.2%; gyrB mutation, 4.4%; gyrA and gyrB mutation, 32.4%; rpoB mutation, 100%, respectively. The resistance related fusA mutation was only found in one isolate with minimum inhibitory concentration of 4 mg/L. ..
  12. Clements A, Magalhães R, Tatem A, Paterson D, Riley T. Clostridium difficile PCR ribotype 027: assessing the risks of further worldwide spread. Lancet Infect Dis. 2010;10:395-404 pubmed publisher
    ..Health departments in countries unaffected by outbreaks should assess the risk of introduction or reintroduction of C difficile PCR ribotype 027 using a structured risk-assessment approach. ..
  13. Hoffer E, Haechler H, Frei R, Stephan R. Low occurrence of Clostridium difficile in fecal samples of healthy calves and pigs at slaughter and in minced meat in Switzerland. J Food Prot. 2010;73:973-5 pubmed
    ..difficile in farm animals at slaughter and retail ground meat in Switzerland is postulated. However, further studies are necessary to confirm these preliminary data and to assess future trends. ..
  14. Kvennefors E, Sampayo E, Ridgway T, Barnes A, Hoegh Guldberg O. Bacterial communities of two ubiquitous Great Barrier Reef corals reveals both site- and species-specificity of common bacterial associates. PLoS ONE. 2010;5:e10401 pubmed publisher
    ..Finally, the results did not support the contention that a single bacterial pathogen may be the causative agent of WS Acroporids on the GBR. ..
  15. Pasanen T, Kotila S, Horsma J, Virolainen A, Jalava J, Ibrahem S, et al. Comparison of repetitive extragenic palindromic sequence-based PCR with PCR ribotyping and pulsed-field gel electrophoresis in studying the clonality of Clostridium difficile. Clin Microbiol Infect. 2011;17:166-75 pubmed publisher
    ..Athens, GA, USA) to PCR ribotyping and pulsed-field gel electrophoresis (PFGE) typing using 205 isolates of C...
  16. Knetsch C, Lawley T, Hensgens M, Corver J, Wilcox M, Kuijper E. Current application and future perspectives of molecular typing methods to study Clostridium difficile infections. Euro Surveill. 2013;18:20381 pubmed
    ..Currently, conventional agarose gel-based polymerase chain reaction (PCR) ribotyping is the most common typing method used in Europe to type C. difficile...
  17. Squire M, Carter G, Mackin K, Chakravorty A, Norén T, Elliott B, et al. Novel molecular type of Clostridium difficile in neonatal pigs, Western Australia. Emerg Infect Dis. 2013;19:790-2 pubmed publisher
    ..We investigated C. difficile prevalence in piglets in Australia and isolated a novel strain with a unique pathogenicity locus. In a mouse infection model, this strain produced more weight loss than did a ribotype 078 strain. ..
  18. Medina Torres C, Weese J, Staempfli H. Prevalence of Clostridium difficile in horses. Vet Microbiol. 2011;152:212-5 pubmed publisher
    ..An overall fecal culture prevalence of 7.01% for C. difficile was identified in 742 fecal samples. PCR-ribotyping and toxin gene identification was performed and seventeen 17 PCR-ribotypes were identified among the 52 C...
  19. Jamal W, Rotimi V, Grubesic A, Rupnik M, Brazier J, Duerden B. Correlation of multidrug resistance, toxinotypes and PCR ribotypes in Clostridium difficile isolates from Kuwait. J Chemother. 2009;21:521-6 pubmed
    ..62% clustered in group II. Although the number of strains toxinotyped was small, ribotyping and toxinotyping correlated well with the published literature, except for 078 with a novel "V-like" ..
  20. Wei H, Kao C, Wei S, Tzen J, Chiou C. Comparison of PCR ribotyping and multilocus variable-number tandem-repeat analysis (MLVA) for improved detection of Clostridium difficile. BMC Microbiol. 2011;11:217 pubmed publisher
    Polymerase chain reaction (PCR) ribotyping is one of the globally accepted techniques for defining epidemic clones of Clostridium difficile and tracing virulence-related strains...
  21. Janezic S, Rupnik M. Molecular typing methods for Clostridium difficile: pulsed-field gel electrophoresis and PCR ribotyping. Methods Mol Biol. 2010;646:55-65 pubmed publisher
    ..restriction analysis, REA; pulsed field gel electrophoresis PFGE; toxinotyping), PCR amplification (PCR ribotyping, arbitrarily primed PCR, multilocus variable-number tandem-repeat analysis MLVA), and sequence analysis (..
  22. Riley T, Thean S, Hool G, Golledge C. First Australian isolation of epidemic Clostridium difficile PCR ribotype 027. Med J Aust. 2009;190:706-8 pubmed
    ..All diagnostic laboratories and health care facilities in Australia should now be on high alert for this organism. ..
  23. Joost I, Speck K, Herrmann M, von Muller L. Characterisation of Clostridium difficile isolates by slpA and tcdC gene sequencing. Int J Antimicrob Agents. 2009;33 Suppl 1:S13-8 pubmed publisher
    ..amplification-length polymorphism by pulsed field gel electrophoresis (PFGE) or polymerase chain reaction (PCR) ribotyping. However, sequence-based methods allow typing technique standardisation and data comparison...
  24. Goorhuis A, Debast S, Dutilh J, van Kinschot C, Harmanus C, Cannegieter S, et al. Type-specific risk factors and outcome in an outbreak with 2 different Clostridium difficile types simultaneously in 1 hospital. Clin Infect Dis. 2011;53:860-9 pubmed publisher
    ..MLVA showed persistent clonal dissemination of types 017 and 027, despite appropriate infection control measures. Patients with CDI have type-specific risk factors and mortality rates, with prolonged clonal spread of type 027 or 017. ..
  25. Guard J, Sanchez Ingunza R, Morales C, Stewart T, Liljebjelke K, Van Kessel J, et al. Comparison of dkgB-linked intergenic sequence ribotyping to DNA microarray hybridization for assigning serotype to Salmonella enterica. FEMS Microbiol Lett. 2012;337:61-72 pubmed publisher
    ..I. Intergenic sequence ribotyping (ISR) evaluated single nucleotide polymorphisms occurring in a 5S ribosomal gene region and flanking sequences ..
  26. Valiente E, Dawson L, Cairns M, Stabler R, Wren B. Emergence of new PCR ribotypes from the hypervirulent Clostridium difficile 027 lineage. J Med Microbiol. 2012;61:49-56 pubmed publisher
    ..We conclude that there should be a heightened awareness of newly identified PCR ribotypes such as 176, 198 and 244, and that they may be as problematic as the notorious 027 strains. ..
  27. Kim H, Jeong S, Roh K, Hong S, Kim J, Shin M, et al. Investigation of toxin gene diversity, molecular epidemiology, and antimicrobial resistance of Clostridium difficile isolated from 12 hospitals in South Korea. Korean J Lab Med. 2010;30:491-7 pubmed publisher
    ..The objective of this study was to characterize clinical isolates of C. difficile obtained from various regions in Korea with regard to their toxin status, molecular type, and antimicrobial susceptibility...
  28. Knetsch C, Hensgens M, Harmanus C, van der Bijl M, Savelkoul P, Kuijper E, et al. Genetic markers for Clostridium difficile lineages linked to hypervirulence. Microbiology. 2011;157:3113-23 pubmed publisher
    ..This provides valuable information on strains belonging to two distinct lineages within C. difficile that are highly related to hypervirulent strains. ..
  29. Stabler R, He M, Dawson L, Martin M, Valiente E, Corton C, et al. Comparative genome and phenotypic analysis of Clostridium difficile 027 strains provides insight into the evolution of a hypervirulent bacterium. Genome Biol. 2009;10:R102 pubmed publisher
    ..This study provides genetic markers for the identification of 027 strains and offers a unique opportunity to explain the recent emergence of a hypervirulent bacterium. ..
  30. Wilcox M, Shetty N, Fawley W, Shemko M, Coen P, Birtles A, et al. Changing epidemiology of Clostridium difficile infection following the introduction of a national ribotyping-based surveillance scheme in England. Clin Infect Dis. 2012;55:1056-63 pubmed
    ..The Clostridium difficile Ribotyping Network (CDRN) was established in 2007 as part of enhanced CDI surveillance in England, to facilitate the ..
  31. Littman R, Willis B, Pfeffer C, Bourne D. Diversities of coral-associated bacteria differ with location, but not species, for three acroporid corals on the Great Barrier Reef. FEMS Microbiol Ecol. 2009;68:152-63 pubmed publisher
    ..These results indicate certain bacterial groups associated specifically with corals, but the dominant bacterial genera differ between geographically-spaced corals. ..
  32. Wolff D, Bruning T, Gerritzen A. Rapid detection of the Clostridium difficile ribotype 027 tcdC gene frame shift mutation at position 117 by real-time PCR and melt curve analysis. Eur J Clin Microbiol Infect Dis. 2009;28:959-62 pubmed publisher
    ..difficile DNA and simultaneous screening for the tcdC gene deletion at position 117, which is closely related to the C. difficile PCR ribotype 027 strain. ..
  33. Silva F, Carmo M, Silbert S, Gales A. SPM-1-producing Pseudomonas aeruginosa: analysis of the ancestor relationship using multilocus sequence typing, pulsed-field gel electrophoresis, and automated ribotyping. Microb Drug Resist. 2011;17:215-20 pubmed publisher
    ..A total of 50 SPM-1-producing P. aeruginosa exhibiting 11 distinct ribotyping genotypes collected from 11 different Brazilian cities were studied. Three IMP-1-producing P...
  34. Lukkarinen H, Eerola E, Ruohola A, Vainionpaa R, Jalava J, Kotila S, et al. Clostridium difficile ribotype 027-associated disease in children with norovirus infection. Pediatr Infect Dis J. 2009;28:847-8 pubmed publisher
    ..Viral gastroenteritis may contribute to epithelial homeostasis of the intestine and exacerbate the effects of toxins produced by C. difficile ribotype 027. ..
  35. Tenover F, Novak Weekley S, Woods C, Peterson L, Davis T, Schreckenberger P, et al. Impact of strain type on detection of toxigenic Clostridium difficile: comparison of molecular diagnostic and enzyme immunoassay approaches. J Clin Microbiol. 2010;48:3719-24 pubmed publisher
    ..All C. difficile strains were typed by PCR-ribotyping. Compared to results for toxigenic culture with enrichment, the sensitivity, specificity, and positive and ..
  36. Tanner H, Hardy K, Hawkey P. Coexistence of multiple multilocus variable-number tandem-repeat analysis subtypes of Clostridium difficile PCR ribotype 027 strains within fecal specimens. J Clin Microbiol. 2010;48:985-7 pubmed publisher
    ..difficile infection cases. ..
  37. Kim S, Kim H, Seo Y, Yong D, Jeong S, Chong Y, et al. Molecular characterization of toxin A-negative, toxin B-positive variant strains of Clostridium difficile isolated in Korea. Diagn Microbiol Infect Dis. 2010;67:198-201 pubmed publisher
    ..We performed pulsed-field gel electrophoresis (PFGE), polymerase chain reaction ribotyping, and toxinotyping in 82 A(-)B(+) clinical isolates in Korea...
  38. Svec P, Kukletova M, Sedláček I. Comparative evaluation of automated ribotyping and RAPD-PCR for typing of Lactobacillus spp. occurring in dental caries. Antonie Van Leeuwenhoek. 2010;98:85-92 pubmed publisher
    ..Folia Microbiol 54:53-58, 2009) was characterized by automated ribotyping performed by the RiboPrinter microbial characterization system and by randomly amplified polymorphic DNA ..
  39. Keessen E, Gaastra W, Lipman L. Clostridium difficile infection in humans and animals, differences and similarities. Vet Microbiol. 2011;153:205-17 pubmed publisher
    ..In this review C. difficile infections in humans and animals are compared. The pathogenesis, clinical signs, diagnosis and prevalence of CDI are described and similarities and differences of CDI between humans and animals are discussed. ..
  40. Xiao M, Kong F, Jin P, Wang Q, Xiao K, Jeoffreys N, et al. Comparison of two capillary gel electrophoresis systems for Clostridium difficile ribotyping, using a panel of ribotype 027 isolates and whole-genome sequences as a reference standard. J Clin Microbiol. 2012;50:2755-60 pubmed publisher
    PCR ribotyping is the most commonly used Clostridium difficile genotyping method, but its utility is limited by lack of standardization...
  41. Tagashira Y, Kato H, Senoh M, Nakamura A. Two cases of fulminant colitis due to binary toxin-positive Clostridium difficile that are not PCR ribotype 027 or type 078. J Med Microbiol. 2013;62:1486-9 pubmed publisher
    ..These isolates yielded identical results by both PCR ribotyping and slpA sequence typing...
  42. Griffiths D, Fawley W, Kachrimanidou M, Bowden R, Crook D, Fung R, et al. Multilocus sequence typing of Clostridium difficile. J Clin Microbiol. 2010;48:770-8 pubmed publisher
    ..difficile MLST genotyping data among laboratories. MLST and PCR ribotyping were similar in discriminatory abilities, having indices of discrimination of 0.90 and 0.92, respectively...
  43. Zaiss N, Witte W, Nubel U. Fluoroquinolone resistance and Clostridium difficile, Germany. Emerg Infect Dis. 2010;16:675-7 pubmed publisher
    ..PCR ribotyping showed high prevalence of ribotype 001 and restricted dissemination of ribotype 027 strains...
  44. Morrow K, Moss A, Chadwick N, Liles M. Bacterial associates of two Caribbean coral species reveal species-specific distribution and geographic variability. Appl Environ Microbiol. 2012;78:6438-49 pubmed publisher
    ..e., phylum versus genus) at which scientists examine coral-microbe associations, in addition to host-elicited factors and environmental fluctuations, must be considered carefully in future studies of the coral holobiont. ..
  45. Zidaric V, Beigot S, Lapajne S, Rupnik M. The occurrence and high diversity of Clostridium difficile genotypes in rivers. Anaerobe. 2010;16:371-5 pubmed publisher
    ..Isolates were distributed into 34 PCR ribotypes, of which more than half are present also in humans and animals. PCR ribotype 014 was the predominate type (16.2% of all isolates). ..
  46. Hopman N, Keessen E, Harmanus C, Sanders I, van Leengoed L, Kuijper E, et al. Acquisition of Clostridium difficile by piglets. Vet Microbiol. 2011;149:186-92 pubmed publisher
    ..This study shows that C. difficile ribotype 078 spreads easily between sows, piglets and the environment. Vertical transmission of C. difficile ribotype 078 was not found and is very unlikely to occur. ..
  47. Janezic S, Strumbelj I, Rupnik M. Use of modified PCR ribotyping for direct detection of Clostridium difficile ribotypes in stool samples. J Clin Microbiol. 2011;49:3024-5 pubmed publisher
    PCR ribotyping was modified to allow direct detection of Clostridium difficile from stool samples. Direct PCR ribotyping was possible in 86 out of 99 C. difficile-positive stool samples, and in 84 cases (84...
  48. Spigaglia P, Barbanti F, Dionisi A, Mastrantonio P. Clostridium difficile isolates resistant to fluoroquinolones in Italy: emergence of PCR ribotype 018. J Clin Microbiol. 2010;48:2892-6 pubmed publisher
    ..C. difficile isolates were typed by PCR ribotyping. In total, 50 clinical isolates showed substitutions in gyr genes and were resistant to fluoroquinolones...
  49. Bakker D, Corver J, Harmanus C, Goorhuis A, Keessen E, Fawley W, et al. Relatedness of human and animal Clostridium difficile PCR ribotype 078 isolates determined on the basis of multilocus variable-number tandem-repeat analysis and tetracycline resistance. J Clin Microbiol. 2010;48:3744-9 pubmed publisher
    ..We conclude that strains from human and porcine origins are genetically related, irrespective of the country of origin. This may reflect a lack of diversity and/or common source. ..
  50. Jamal W, Rotimi V, Brazier J, Duerden B. Analysis of prevalence, risk factors and molecular epidemiology of Clostridium difficile infection in Kuwait over a 3-year period. Anaerobe. 2010;16:560-5 pubmed publisher
    ..Laboratory, Faculty of Medicine, Kuwait University for Clostridium difficile toxin detection, culture and PCR ribotyping. During the period, 73 (10.5%) out of 697 patients met the case definition of CDI. Of these, 56 (76...
  51. Elliott B, Squire M, Thean S, Chang B, Brazier J, Rupnik M, et al. New types of toxin A-negative, toxin B-positive strains among clinical isolates of Clostridium difficile in Australia. J Med Microbiol. 2011;60:1108-11 pubmed publisher
    ..Of these, six (66.7?%) were binary toxin-positive by PCR. Using PCR ribotyping and toxinotyping, the A(-)B(+) strains could be grouped into seven ribotypes and three toxinotypes...
  52. Tae C, Jung S, Song H, Kim S, Choi H, Lee M, et al. The first case of antibiotic-associated colitis by Clostridium difficile PCR ribotype 027 in Korea. J Korean Med Sci. 2009;24:520-4 pubmed publisher
    ..C. difficile isolated both at the first and the last admission was identified as C. difficile ribotype 027 by ribotyping, toxinotyping, and tcdC gene sequencing, which turned out the same pathogen as the epidemic hypervirulent B1/..
  53. Goorhuis A, Legaria M, Van den Berg R, Harmanus C, Klaassen C, Brazier J, et al. 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. Clin Microbiol Infect. 2009;15:1080-6 pubmed publisher
    ..We conclude that C. difficile type 017 gradually replaced other circulating PCR ribotypes and that MLVA provides detailed insight into nosocomial spread. ..