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Increasing incidence of Clostridium difficile infection, Australia, 2011–2012

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Global rates of hospital-associated Clostridium difficile infection (HA-CDI) have increased dramatically over the past 10 years. The emergence of fluoroquinolone-resistant C. difficile polymerase chain reaction (PCR) ribotype (RT) 027 in North America in 2003 and in Europe in 2005 has been associated with increased morbidity and mortality.1,2 The appearance of RT027 in Australia was delayed, with the first reported case occurring in Western Australia in 2009 in a patient who apparently acquired the infection overseas.3 The first case of locally acquired infection did not occur until 2010 in Melbourne, Victoria.4 The reasons for this delay are unclear but could be due to Australia’s geography, which may impede the introduction of new strains into the country, and slow their spread due to the distances between major cities.5 Also, Australia’s conservative policies on fluoroquinolone use in humans and animals6 may have offered some protection.

Rates of community-associated CDI (CA-CDI) are also increasing worldwide.