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Mark Miller, Denise Gravel, Michael Mulvey, Reply to Pillai et al, Clinical Infectious Diseases, Volume 50, Issue 12, 15 June 2010, Pages 1686–1687, https://doi.org/10.1086/653008
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Extract
To the Editor—The letter by Pillai et al [1] is an interesting addition to the current knowledge of the epidemiology of Clostridium difficile infection (CDI) in Canada. Their data are actually not very different from the data that we recently published in our Canadian survey [2]; it merely represents a different time period being analyzed.
Our recently published national CDI survey, conducted by the Canadian Nosocomial Infection Surveillance Program (CNISP), was performed in 2005 and reflects the state of CDI in CNISP hospitals at that time [2]. Pillai et al [1] conducted their analysis of C. difficile strains in Ontario 3–4 years later in 2008–2009. Our 2005 data show that 20% of cases of CDI at Ontario CNISP sites were caused by the North American pulsed-field type 1 (NAP1) strain, and their 2008–2009 data show that 53% of “outbreak” strains in Ontario were NAP1, by use of electrophoretic typing. In fact, follow-up CDI surveillance in CNISP hospitals showed that the percentages of C. difficile strains that were NAP1 in Ontario were 48% in 2007 and 43% in 2008 [3]—not much different from the 53% reported by Pillai et al [1], despite the fact that their strain collection originated from institutional outbreaks.
