Outbreaks of Clostridium difficile associated diarrhoea (CDAD) involving the virulent PCRribotype 027, toxinotype III were first reported in the Netherlands in 2005. This ribotype has now been detected in 26 of the 97 hospitals in the Netherlands. In 13 of the hospitals, the introduction of ribotype 027 was linked to increased CDAD incidence; this was found in 2 hospitals since December 2006. Ribotype 027 has also been detected in to nursing homes. In 2007, no evidence of ribotype 27 was found in 6 of the 12 hospitals in which ribotype 027 was confirmed in 2005-2006 and an outbreak of CDAD had occurred. The incidence of CDAD increased again in 2 hospitals that had previously had the epidemic well under control. Meanwhile, other PCR ribotypes appear to be gaining ground in the Netherlands, some of which have the same virulent characteristics as ribotype 027. Notably, ribotype 078, which appears to be associated with livestock, is becoming increasingly common.