dWe describe a novel, semiautomated Clostridium difficile typing platform that is based on PCR-ribotyping in conjunction with a semiautomated molecular typing system. The platform is reproducible with minimal intra-or interassay variability. This method exhibited a discriminatory index of 0.954 and is therefore comparable to more arduous typing systems, such as pulsedfield gel electrophoresis. C lostridium difficile, the etiological agent of C. difficile infection (CDI), is an important cause of both hospital-and community-acquired infectious diarrhea (1, 2). The emergence of hypervirulent C. difficile isolates and in particular the NAP1/BI/027 isolate has altered the epidemiology of C. difficile infections in many health care institutions, resulting in increased severity and duration of disease, with concomitant increases to the length and cost of hospitalization (1). Therefore, typing methods that can discriminate NAP1/BI/027 and other emerging hypervirulent C. difficile isolates may be important for understanding the transmission dynamics of the organism. In addition, it has recently been demonstrated that the analytical sensitivity and specificity of C. difficile diagnostic assays may be dependent on the C. difficile strain type (3). In addition, recent reports suggest that the relapse rate following treatment with certain novel antianaerobic and C. difficile-specific antimicrobials could correlate with C. difficile strain type (4, 5); thus, an appreciation of the isolate type may play a role in patient management in the future. As such, C. difficile typing may have the potential to improve the management of CDI beyond clinical surveillance, especially in the hospital setting, and it may be important for clinical laboratorians and infection control specialists to have a baseline understanding of the different C. difficile isolates circulating in their institutions.Pulsed-field gel electrophoresis (PFGE) is the principal reference method employed for C. difficile typing in North America (6). While PFGE affords acceptable discriminatory power (6), it does suffer from some important limitations, in particular the labor intensity, technical expertise, turnaround time, and necessity for control strains to be processed alongside isolates of epidemiological interest. In Europe, the predominant method for C. difficile typing is PCR-ribotyping, which involves the PCR amplification of the intergenic space region between the 16S and 23S rRNA genes (7,8,9). For many years, epidemiologic studies for C. difficile have relied on PFGE and PCR-ribotyping to determine strain relatedness; multiple-locus variable-number tandem-repeat analysis (MLVA) for C. difficile typing has also been described for recent studies (6,10,11, 12). Although this method does appear to be reproducible and discriminatory, it requires access to a genetic analyzer/DNA sequencer, which is cost prohibitive to many laboratories. The objective of this study was to develop and validate a semiautomated PCR-ribotyping platform that would further reduce labor...