How should we respond to the highly toxogenic NAP1/ribotype 027 strain of Clostridium difficile?
Thomas J. Louie Dr. Louie is with the Infectious Diseases Division, Department of Medicine, University of Calgary, and is Medical Director, Infection Prevention & Control, Calgary Health Region Hospitals, Calgary, Alta. Correspondence to: Dr. Thomas J. Louie, Rm AGW5, Foothills Medical Centre, 1403 29 St. NW, Calgary AB T2N 2T9 It is common knowledge across Canada and elsewhere that multiple hospitals in Quebec have experienced a disastrous and highly lethal outbreak of nosocomial Clostridium difficile-associated disease (CDAD) in the past 2 years. Unaffected regions may be indeed be thankful that they have not been confronted with this formidable foe. It has recently been determined that two-thirds of the nosocomial cases in the Sherbrooke region (and a similar proportion in other hospitals within Quebec) were the result of infection with one strain, a ribotype 27, North American pulso-type 1 (NAP1), toxinotype III organism that makes roughly 15 20 times the amount of toxin as “normal
