Student or educator? Sign up with your school email and get 6 months of Pro free.
Cited by 735

The DOI matches its Crossref record; 4 of the 4 references it cites were found in a registry or an index.

Emergence and global spread of epidemic healthcare-associated Clostridium difficile

Open access
He, Miao, Miyajima, Fabio, Roberts, Paul, Ellison, Louise, Pickard, Derek J, Martin, Melissa J, Connor, Thomas R, Harris, Simon R, Fairley, Derek, Bamford, Kathleen B, D'Arc, Stephanie, Brazier, Jon, Brown, Derek, Coia, John E, Douce, Gill, Gerding, Dale, Kim, Hee Jung, Koh, Tse Hsien, Kato, Haru, Senoh, Mitsutoshi, Louie, Tom, Michell, Stephen, Butt, Emma, Peacock, Sharon J, Brown, Nick M, Riley, Tom, Songer, Glen, Wilcox, Mark, Pirmohamed, Munir, Kuijper, Ed, Hawkey, Peter, Wren, Brendan W, Dougan, Gordon, Parkhill, Julian, Lawley, Trevor D·2013·Nature Genetics

Abstract

Epidemic C. difficile (027/BI/NAP1) has rapidly emerged in the past decade as the leading cause of antibiotic-associated diarrhea worldwide. However, the key events in evolutionary history leading to its emergence and the subsequent patterns of global spread remain unknown. Here, we define the global population structure of C. difficile 027/BI/NAP1 using whole-genome sequencing and phylogenetic analysis. We show that two distinct epidemic lineages, FQR1 and FQR2, not one as previously thought, emerged in North America within a relatively short period after acquiring the same fluoroquinolone resistance–conferring mutation and a highly related conjugative transposon. The two epidemic lineages showed distinct patterns of global spread, and the FQR2 lineage spread more widely, leading to healthcare-associated outbreaks in the UK, continental Europe and Australia. Our analysis identifies key genetic changes linked to the rapid transcontinental dissemination of epidemic C. difficile 027/BI/NAP1 and highlights the routes by which it spreads through the global healthcare system.

Overview

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1038/ng.2478

Cites

4 of 4 references verified0 citation errors · 0 not checkable

Statistics

Verification

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Citations

Cites

Show all 4 references

Cited by

See all 735

Metadata

Authors
He, M., Miyajima, F., Roberts, P., Ellison, L., Pickard, D. J., Martin, M. J., Connor, T. R., Harris, S. R., Fairley, D., Bamford, K. B., D'Arc, S., Brazier, J., Brown, D., Coia, J. E., Douce, G., Gerding, D., Kim, H. J., Koh, T. H., Kato, H., Senoh, M., Louie, T., Michell, S., Butt, E., Peacock, S. J., Brown, N. M., Riley, T., Songer, G., Wilcox, M., Pirmohamed, M., Kuijper, E., Hawkey, P., Wren, B. W., Dougan, G., Parkhill, J., & Lawley, T. D.
Venue
Nature Genetics
Published
2012-12-09
Volume
45
Issue
1
Pages
109-113
ISSN
  • 1061-4036 (ISSN-L)
  • 1546-1718
OpenAlex
W2161990844
Cited by
735
References
4
FWCI
39.26
Type
journal article
Language
en
Open access
green

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review

How to cite

Cite CoChat for the checks on this page, and the paper for its own findings.

This page
CoChat. (2026). Citation check: Emergence and global spread of epidemic healthcare-associated Clostridium difficile. https://app.cochat.ai/papers/10.1038/ng.2478
The paper
He, M., Miyajima, F., Roberts, P., Ellison, L., Pickard, D. J., Martin, M. J., Connor, T. R., Harris, S. R., Fairley, D., Bamford, K. B., D'Arc, S., Brazier, J., Brown, D., Coia, J. E., Douce, G., Gerding, D., Kim, H. J., Koh, T. H., Kato, H., . . . Lawley, T. D. (2013). Emergence and global spread of epidemic healthcare-associated Clostridium difficile. Nature Genetics. https://doi.org/10.1038/ng.2478

Data sources

Bibliographic data: Semantic Scholar, OpenAlex, Crossref.

Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).

Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.