To the Editor—We agree with Collins and Riley and thank them for their more accurate appraisal of the epidemiology of the epidemic Clostridium difficile ribotype (RT) 027 strain in Asia [1]. As noted, this strain has been linked to outbreaks of severe disease in North America and Europe, and fluoroquinolone use likely facilitated its dissemination [1, 2]. A targeted intervention including fluoroquinolone restriction resulted in a dramatic decrease in the prevalence of the RT027 strain by 2010 in England and is a reminder that antibiotic stewardship may be particularly helpful in the control of this highly fluoroquinolone-resistant strain [3]. Continued molecular surveillance of C. difficile strain prevalence worldwide remains important to detect trends in the prevalence and incidence of the RT027 strain, as well as other epidemic strains, including the RT017 strain commonly identified in Asian surveys.

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回复柯林斯和莱利

致编辑-我们同意Collins和Riley的观点，并感谢他们对亚洲流行的艰难梭菌核糖型（RT）027菌株的流行病学进行了更准确的评估[1]。如上所述，该菌株与北美和欧洲爆发的严重疾病有关，使用氟喹诺酮可能有助于其传播[1、2]。有针对性的干预措施包括限制氟喹诺酮类药物的使用，到2010年在英格兰导致RT027菌株的流行率急剧下降，这提醒人们，抗生素的管理可能特别有助于控制这种对氟喹诺酮类药物具有高度耐药性的菌株[3]。艰难梭菌的持续分子监测 全世界的毒株流行率对于检测RT027毒株以及其他流行毒株（包括亚洲调查中普遍确定的RT017毒株）的流行和发病率趋势仍然很重要。