Category Archives: Clostridium difficile

01Oct / 2013

The role of hospital transmission in Clostridium difficile infection

This week the Modernising Medical Microbiology consortium at Oxford published the findings of a six-year study into the transmission of the hospital "superbug" Clostridium difficile. The research, which appears in the New England Journal of Medicine, shows that the majority of new cases cannot be traced to other infections in hospital, and indicates instead that there must be a large, as yet unidentified, reservoir of C. difficile infectious to humans. This finding is important because it suggests that there is a limit to which more and more intense hospital cleaning - important though it has been - can continue to have in reducing C. difficile infection.

The research, which is the result of a tireless effort by a large number of my colleagues - notably David Eyre, Tim Peto and Sarah Walker - used bacterial whole genome sequencing to detect within-hospital transmission by searching for extremely closely related bacterial strains among more than 1200 cases of C. difficile infection that occurred in Oxfordshire between September 2007 and March 2011. The consortium is currently developing the approach for routine microbiology diagnostics and infection control, with a view to eventual roll-out across the NHS.

Posted by in Clostridium difficile, David Eyre, Genomics, Modernising Medical Microbiology, New England Journal of Medicine, Sarah Walker, Tim Peto

Permalink

20Sep / 2013

Postdoctoral Position in Statistical Genomics

The position of Postdoctoral Scientist is available in my group to lead research on the Wellcome Trust and Royal Society funded project Statistical Methods for Whole Genome Phenotype Mapping in Bacterial Populations.

Bacteria cause disease throughout the world. Different strains vary in disease severity, but the genetic variants responsible remain largely undiscovered. Recent breakthroughs in whole genome sequencing provide new opportunities for discovery, but the lack of statistical analysis tools tailored to the special structure of bacterial populations presents a roadblock. The goal of the project is to develop an analysis framework for mapping genes underlying naturally variable traits in bacterial populations. Focusing on the hospital-associated pathogens Staphylococcus aureus and Clostridium difficile, we will investigate the role of bacterial variants on disease severity.

The role of the Postdoctoral Scientist is to develop novel statistical methods for analysing genotype-phenotype associations in bacteria at the whole genome level. The successful candidate will write software implementing the statistical methods and apply them to design and carry out investigations into the genetic basis of virulence in natural populations of bacterial pathogens. The ideal candidate would be a recently graduating PhD student with experience of statistical genetics and computer programming, with evidence of publicly released software. Experience of population genetics or microbiology would be advantageous but is not essential.

The post is available immediately, and is available for up to 3 years in the first instance. For more details on this position, including salary, job description, selection criteria and how to apply, please see the University of Oxford recruitment page.

Applications for this vacancy are to be made online. The closing date is 12.00 noon on Monday 4 November 2013. Applicants will be asked to upload a CV and a supporting statement as part of the online application. For informal enquiries, please email me. More information about the group's research is available here.

Posted by in Clostridium difficile, Nuffield Department of Medicine, Oxford, Recruitment, Staphylococcus aureus, Virulogenomics

Permalink

17Sep / 2013

Sir Henry Dale Fellowship

I am pleased to report that I have been awarded a Wellcome Trust and Royal Society funded Sir Henry Dale Fellowship. The subject of the fellowship, to be held in the Nuffield Department of Medicine at the University of Oxford, is Statistical Methods for Whole Genome Phenotype Mapping in Bacterial Populations.

The project addresses the question of how to detect genes or mutations in bacteria responsible for variability in important traits such as the tendency to cause human disease. Focusing on the hospital-associated pathogens Staphylococcus aureus and Clostridium difficile, the project has the potential to help identify genetic variants that explain why some bacteria cause more severe infections, knowledge that could help develop new drugs and tests that improve patient treatment.

The fellowship runs for five years, and includes support for a postdoctoral research assistant and laboratory costs. I will be advertising a position shortly. If you are interested, please get in touch.

I want to thank the funders and reviewers for supporting this project, and my colleagues who helped me write and re-write the research proposal.

Posted by in Bacteria, Clostridium difficile, royal society, Sir Henry Dale Fellowship, Staphylococcus aureus, Virulogenomics, Wellcome Trust

Permalink

06Jun / 2013

Detecting mixed strain infections with whole genome sequencing

Whole genome sequencing in near-to-real time is set to become a routine tool for outbreak detection by hospital and public health microbiology labs, following successful pilot studies in the UK last year. Typically, the bacteria are cultured from a clinical sample, and a single colony is picked for sequencing. Since a bacterial colony grows from a single cell, this procedure ensures that all the cells picked for sequencing are genetically identical, and this in turn helps piece the genome back together again following sequencing.

But it exposes the system to a flaw. What would happen if a patient sick with two strains transmitted one, but not the other to a second patient? Characterizing the genome of just one of the strains in the first patient risks missing the transmission event entirely, because the "wrong" strain might have been sequenced.

One safeguard would be to sequence multiple bacterial colonies per sample, three for example. But this would increase the cost of routine surveillance three-fold.

In a new paper published this month in PLoS Computational Biology, with David Eyre, Madeleine Cule, Sarah Walker and others, we have investigated an alternative solution, where by a large number of colonies gets sequenced all together. The cost is the same as that of sequencing a single colony. But the downstream bioinformatics analysis is complicated considerably by the presence of multiple strains. To cope with this, we developed a new computational method that reconstructs the identities of the multiple strains, using a panel of reference genomes to help where possible.

By applying the approach to 26 clinical samples of Clostridium difficile hospital infections with known epidemiological relationships, we detected four mixed strain infections, one of which revealed a previously undetected transmission event within the hospital. For full details, read the open access paper.

Posted by in Clostridium difficile, David Eyre, Genomics, Madeleine Cule, PLOS Computational Biology, Sarah Walker, Transmission

Permalink

13Aug / 2012

Nature Reviews Genetics: Transforming Clinical Microbiology

My colleagues Xavier Didelot, Rory Bowden, Tim Peto, Derrick Crook and I have just published a review online ahead of print in Nature Reviews Genetics called Transforming clinical microbiology with bacterial genome sequencing.

You might also be interested to read a similarly themed review recently published by our friends at the University of Cambridge and Wellcome Trust Sanger Institute in PLoS Pathogens titled Routine use of microbial whole genome sequencing in diagnostic and public health microbiology.

These review articles follow hot on the heels of a pair of research articles published by our two groups: A pilot study of rapid benchtop sequencing of Staphylococcus aureus and Clostridium difficile for outbreak detection and surveillance in BMJ Open and Rapid whole-genome sequencing for investigation of a neonatal MRSA outbreak in the New England Journal of Medicine. The common thread is the impact of near-to-real-time whole genome sequencing on outbreak detection and other translational activities in hospitals and public health laboratories.

Posted by in Clostridium difficile, Derrick Crook, Nature Reviews Genetics, PLoS Pathogens, Rory Bowden, Staphylococcus aureus, Tim Peto, Wellcome Trust Sanger Institute, Xavier Dideleot

Permalink

18Sep / 2010

Evolutionary Genetics for Translational Research

This month saw the 2010 Infectious Disease Genomics & Global Health meeting at Hinxton, which attracted a good number of people involved in the Modernising Medical Microbiology consortium, of which I am a participant. Rory Bowden and Rosalind Harding presented our group's progress on piecing together intra-host evolution of Staphylococcus aureus and reconstructing transmission chains in Clostridium difficile. My role in the projects has so far been one of assisting in ongoing evolutionary analyses and collaborating in the design of bioinformatics pipelines to make sense of the raw Illumina short-read sequencing data. At the same time I have been devising research plans for my own group, and spending time in the lab preparing sequencing experiments with Bernadette Young. In the poster I presented at Hinxton (available here), and at an internal talk I gave earlier in the year (slides here) I set out what I see as the strengths of Evolutionary Genetics for addressing translational medical problems including
  • Tracking the transmission of hospital-acquired pathogens
  • Understanding transmission dynamics at the population level
  • Identifying the mechanistic and adaptive basis of disease
  • Explaining how pathogens emerge, persist and spread globally
Of the many stimulating talks at the Hinxton conference, those by Dominic Kwiatkowski on the population genomics of Plasmodium falciparum, Christophe Fraser on "hyper-recombination" in Streptococcus pneumoniae and Paul Keim on the challenges for understanding the population genetics of non-clonal bacterial pathogens particularly interested me. Prof Keim gave an equally captivating talk the following day at the Health Protection 2010 meeting in Warwick on his microbial forensics work tracing the origin of Bacillus anthracis spores used in bioterrorism attacks. What I especially admired about his presentations was the dogged pursuit of new methods and ways of thinking in order to better address the biological questions at hand.

Posted by in Bernadette Young, Christophe Fraser, Clostridium difficile, Dominic Kwiatkowski, Modernising Medical Microbiology, Paul Keim, Rory Bowden, Rosalind Harding, Staphylococcus aureus

Permalink

27Feb / 2010

Postdoc and PhD position available

These positions are now closed.

Advertised today in Nature and on Thursday in New Scientist are two positions in my lab. I am looking for a postdoc and a PhD student to work on the genome evolution and epidemiology of four human pathogens as part of the Modernising Medical Microbiology project. Three of the pathogens share the theme of hospital-acquired infections: they are Staphylococcus aureus (of MRSA infamy), Clostridium difficile and norovirus (aka winter vomiting disease). The fourth is Mycobacterium tuberculosis (TB) which is a re-emerging problem in developed countries.

The aim of the project is to use whole genome sequencing of many isolates (100s to 1000s) in order to reconstruct evolutionary relationships and deconstruct transmission routes. We hope to develop the technology to the stage that we can trace the spread of pathogens in real time, and uncover the epidemiological triggers for the spread of disease.

As of January I have relocated to the Nuffield Department of Clinical Medicine at the University of Oxford, and the project is a collaborative affair between people at Oxford (including Rory Bowden, Derrick Crook, Peter Donnelly and Rosalind Harding), the Wellcome Trust Sanger Institute, the NHS and the Health Protection Agency. The project is funded by the UKCRC and further details of the positions are available online for the postdoc and PhD studentship. The closing date for applications is Friday, 2 April 2010.

Posted by in Clostridium difficile, Lab business, Modernising Medical Microbiology, Mycobacterium tuberculosis, norovirus, Oxford, Staphylococcus aureus

Permalink