A severe Clostridioides difficile ribotype 027 infection in Beijing, China, July 2024

Sep 30, 2026

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Clostridioides difficile ribotype (RT) 027 is highly virulent and can lead to life-threatening outcomes including ileus, toxic megacolon, hypotension, or shock. Reports of RT027 outbreaks have been more common outside China, while within China they have been relatively sporadic. This study presents a toxic megacolon case from Beijing caused by RT027 and applies whole genome sequencing to trace the infectious source, alongside agar dilution for antimicrobial susceptibility testing.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusions

Background

Epidemiology and genotyping

Whole-genome sequencing context

Chen et al. BMC Infectious Diseases (2026) 26:23 BMC Infectious Diseases [https://doi.org/10.1186/s12879-025-12195-5](https://doi.org/10.1186/s12879-025-12195-5) RESEARCH Open Access A severe Clostridioides difficile ribotype 027 infection in Beijing, China, July 2024 Xinfei Chen1,2†, Yang Chen3†, Han Zhang1,2†, Wen Shi3, Houpeng Wong4,5, Jin Li 1,2, Ziyue Zhou6, Feiyi Liu 1,2,4, Yiying Zhao1,2, Yingchun Xu1,2* and Meng Xiao1,2* Abstract Background Clostridioides difficile ribotype (RT) 027 is particularly virulent, capable of causing severe conditions such as ileus, toxic megacolon, hypotension, or shock. Outbreaks of RT027 C. difficile are more frequently reported abroad compared to China. Methods We present a case of toxic megacolon caused by an RT027 C. difficile infection and trace the source of the infectious agent using whole genome sequencing. The agar dilution approach was utilized to determine antimicrobial susceptibility. Results Phylogenetic analysis demonstrated that the origin of this isolate was located in the same bifurcating branch of strains previously isolated in Beijing in 2012, yet it clusters within a new subcluster. The single nucleotide polymorphism (SNP) differences between this strain and other isolates from mainland China range from 1 to 16, and the SNP differences between mainland China strains and international strains within the FQR1 lineage range from 7 to 37. Conclusions The emergence of hypervirulent RT027 C. difficile necessitates an accurate tracing of its source. Whole genome sequencing can aid in precisely identifying origins. Although RT027 C. difficile remains primarily sporadic in China, enhanced surveillance of C. difficile and stringent hospital infection control measures is imperative. Keywords Clostridioides difficile, Ribotype 027, Whole-genome sequencing †Xinfei Chen, Yang Chen, and Han Zhang have contributed equally to this work. *Correspondence: Yingchun Xu [xycpumch@139.com](xycpumch@139.com)[ ](xycpumch@139.com)Meng Xiao [cjtcxiaomeng@aliyun.com](cjtcxiaomeng@aliyun.com) 1Department of Laboratory Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China 2Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases (BZ0447), Beijing, China 3Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China 4Graduate School, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China 5Department of Critical Care Medicine, Peking Union Medical College Hospital, Beijing, China 6Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creati](http://creati)[vecommons.org/licenses/by-nc-n

FAQs

What makes ribotype 027 of Clostridioides difficile particularly dangerous?

RT027 is described as especially virulent and capable of severe clinical conditions such as ileus, toxic megacolon, hypotension, or shock.

How did the study trace the source of the RT027 infection?

The source was traced using whole genome sequencing, and antimicrobial susceptibility was determined using the agar dilution approach.

What did phylogenetic and SNP analyses show about the Beijing isolate?

Phylogenetic analysis indicated the isolate shares a branch with Beijing strains previously isolated in 2012 but clusters in a new subcluster, with reported SNP differences ranging from 1 to 16 compared with certain mainland China isolates.

Sep 30, 2026

Uploaded by Franzy