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L Clifford McDonald, Dale N Gerding, Stuart Johnson, Reply to Collins and Riley, Clinical Infectious Diseases, Volume 67, Issue 10, 15 November 2018, Page 1640, https://doi.org/10.1093/cid/ciy251
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To the Editor—We agree with Collins and Riley and thank them for their more accurate appraisal of the epidemiology of the epidemic Clostridium difficile ribotype (RT) 027 strain in Asia [1]. As noted, this strain has been linked to outbreaks of severe disease in North America and Europe, and fluoroquinolone use likely facilitated its dissemination [1, 2]. A targeted intervention including fluoroquinolone restriction resulted in a dramatic decrease in the prevalence of the RT027 strain by 2010 in England and is a reminder that antibiotic stewardship may be particularly helpful in the control of this highly fluoroquinolone-resistant strain [3]. Continued molecular surveillance of C. difficile strain prevalence worldwide remains important to detect trends in the prevalence and incidence of the RT027 strain, as well as other epidemic strains, including the RT017 strain commonly identified in Asian surveys.
Notes
Disclaimer. The findings and conclusions in this report are those of the authors, and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the US Department of Veterans Affairs.
Potential conflict of interest. D. G. has served as a board member for Rebiotix, Merck, Actelion, Summit, and DaVolterra and as a consultant for Pfizer, Sanofi Pasteur, and MGB Pharma. D. G. has also received a grant from Seres Therapeutics and holds patents and technology for the treatment and prevention of nontoxogenic Clostridium difficile [make sure this is italicized] infection under NTCD, LCC. S. J. has served on the advisory boards for Bio-k+, Synthetic Biologics, Summit Therapeutics, and CutisPharma and has served on Pfizer’s data safety monitoring board for vaccine study. S. J. has received payment for lectures from Merck for activities outside of the submitted work All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
