# Epidemiological and Genomic Characteristics of the Widely Disseminated C. difficile Strain, REA Group Y

> **NIH VA IK2** · VA SALT LAKE CITY HEALTHCARE SYSTEM · 2024 · —

## Abstract

Clostridioides difficile is a gram-positive, spore forming, anaerobic bacteria that is the
cause of the most common healthcare associated infection. C. difficile infections (CDI) are
estimated to cause nearly 450,000 infections and 30,000 deaths within the United States per year.
Since the early 2000s, the epidemic strain identified as restriction endonuclease analysis (REA)
group BI, PCR ribotype (RT) 027 (BI/RT027) has been the most common cause of CDI in the
United States. However, in the past 10 years there has been a drastic change in the molecular
epidemiology of C. difficile as BI/RT027 prevalence has decreased. Furthermore, there is
evidence that healthcare-associated CDI (HA-CDI) is on the decline and community-associated
CDI (CA-CDI) is increasing. One strain identified as REA group Y, which commonly correlates to
RT 014 and 020 [Y(RT014/020)], has been endemic in the United States accounting for >5% of
all CDI since the 1980s. As BI/RT027 associated CDI has decreased over the past 10 years,
Y(RT014/020) related CDI have steadily increased and now account for 10-15% of all CDI. With
the rise in CA-CDI, there is rising evidence that Y(RT014/020) resides within an unknown
community reservoir. Despite a decades long prevalence and increasing concern with CA-CDI, a
detailed molecular analysis of Y(RT014/020) has never been completed. Therefore, our proposal
will be to complete a detailed molecular and clinical analysis in conjunction with a rigorous
genomic analysis of Y(RT014/020) and BI/RT027 to assess the factors which contribute towards
our overarching hypothesis that Y(RT014/020) resides within an unknown community reservoir.
 Support from the career development award (CDA) will provide Dr. Skinner with the
necessary foundation and training to establish himself as a successful VA biomedical and
laboratory clinician-scientist focused on the pathogenesis and epidemiology of C. difficile. The
molecular epidemiology of C. difficile has continually shifted over multiple decades. These shifts
are the results of underlying pathologic factors which influence strain selection. This innovative
project will utilize C. difficile from multiple decades to understand the factors which have allowed
for one strain (REA group Y) to remain endemic for decades. This information could be further
utilized to understand which factors (i.e., antibiotic exposure) place Veterans at risk for developing
a CDI and provide a deeper understanding into the mechanisms by which C. difficile is resistant
to particular antibiotics. Therefore, the completion of this CDA will provide a critical foundation for
Dr. Skinner and results from this project will be used to support Dr. Skinner's VA Merit Review
application to study the mechanism by which C. difficile is resistant to certain cephalosporin
antimicrobials.

## Key facts

- **NIH application ID:** 11112724
- **Project number:** 7IK2BX005609-03
- **Recipient organization:** VA SALT LAKE CITY HEALTHCARE SYSTEM
- **Principal Investigator:** Andrew Michael Skinner
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 7
- **Project period:** 2022-10-01 → 2027-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11112724

## Citation

> US National Institutes of Health, RePORTER application 11112724, Epidemiological and Genomic Characteristics of the Widely Disseminated C. difficile Strain, REA Group Y (7IK2BX005609-03). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/11112724. Licensed CC0.

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