Coinfection and Emergence of Rifamycin Resistance during a Recurrent Clostridium difficile Infection

Research output: Contribution to journalArticlepeer-review


  • Emma Stevenson
  • Sarah Kuehne
  • Giles Major
  • Robin Spiller
  • Nigel P Minton

Colleges, School and Institutes

External organisations

  • University of Nottingham
  • Queens Medical Centre, Nottingham, UK.


Clostridium difficile (Peptoclostridium difficile) is a common health care associated infection with a disproportionately high incidence in elderly patients. Disease symptoms range from mild diarrhoea through to life threatening pseudomembranous colitis. Around 20% of patients may suffer recurrent disease which often requires re-hospitalisation of patients.

C. difficile was isolated from stool samples from a patient with two recurrent C. difficile infections. PCR-ribotyping, whole genome sequencing and phenotypic assays were used to characterise these isolates.

Genotypic and phenotypic screening of C. difficile isolates revealed multiple PCR-ribotypes present, and the emergence of rifamycin resistance during the infection cycle.

Understanding both the clinical and bacterial factors that contribute to the course of recurrent infection could inform strategies to reduce recurrence.


Original languageEnglish
Pages (from-to)2689-2694
Number of pages6
JournalJournal of Clinical Microbiology
Issue number11
Early online date24 Aug 2016
Publication statusPublished - Nov 2016


  • Clostridium difficile , relapse , rifaximin , rifampicin