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ABSTRACTThe occurrence ofClostridium difficilein nine wastewater treatment plants in the Ticino Canton (southern Switzerland) was investigated. The samples were collected from raw sewage influents and from treated effluents. Forty-seven out of 55 characterizedC. difficilestrains belonged to 13 different reference PCR ribotypes (009, 010, 014, 015, 039, 052, 053, 066, 070, 078, 101, 106, and 117), whereas 8 strains did not match any of those available in our libraries. The most frequently isolated ribotype (40%) was 078, isolated from six wastewater treatment plants, whereas ribotype 066, a toxigenic emerging ribotype isolated from patients admitted to hospitals in Europe and Switzerland, was isolated from the outgoing effluent of one plant. The majority of the isolates (85%) were toxigenic. Forty-nine percent of them produced toxin A, toxin B, and the binary toxin (toxigenic profile A+B+CDT+), whereas 51% showed the profile A+B+CDT−. Interestingly, eight ribotypes (010, 014, 015, 039, 066, 078, 101, and 106) were among the riboprofiles isolated from symptomatic patients admitted to the hospitals of the Ticino Canton in 2010. Despite the limitation of sampling, this study highlights that toxigenic ribotypes ofC. difficileinvolved in human infections may occur in both incoming and outgoing biological wastewater treatment plants. Such a finding raises concern about the possible contamination of water bodies that receive wastewater treatment plant effluents and about the safe reuse of treated wastewater.

Plesiomonas shigelloides is an emerging pathogen that is widespread in the aquatic environment and is responsible for intestinal diseases and extraintestinal infections in humans and other animals. Virtually nothing is known about its genetic diversity, population structure, and evolution, which severely limits epidemiological control. We addressed these questions by developing a multilocus sequence typing (MLST) system based on five genes (fusA, leuS, pyrG, recG, and rpoB) and analyzing 77 epidemiologically unrelated strains from several countries and several ecological sources. The phylogenetic position of P. shigelloides within family Enterobacteriaceae was precisely defined by phylogenetic analysis of the same gene portions in other family members. Within P. shigelloides, high levels of nucleotide diversity (average percentage of nucleotide differences between strains, 1.49%) and genotypic diversity (64 distinct sequence types; Simpson's index, 99.7%) were found, with no salient internal phylogenetic structure. We estimated that homologous recombination in housekeeping genes affects P. shigelloides alleles and nucleotides 7 and 77 times more frequently than mutation, respectively. These ratios are similar to those observed in the naturally transformable species Streptococcus pneumoniae with a high rate of recombination. In contrast, recombination within Salmonella enterica, Escherichia coli, and Yersinia enterocolitica was much less frequent. P. shigelloides thus stands out among members of the Enterobacteriaceae. Its high rate of recombination results in a lack of association between genomic background and O and H antigenic factors, as observed for the 51 serotypes found in our sample. Given its robustness and discriminatory power, we recommend MLST as a reference method for population biology studies and epidemiological tracking of P. shigelloides strains.Plesiomonas shigelloides is a species of rod-shaped gramnegative bacteria recently classified in the family Enterobacteriaceae and is the only oxidase-positive member of this family (32). Freshwater and estuarine water are considered to be the natural environment of P. shigelloides (36), which is often isolated from fish and seafood (30,42). Like many Enterobacteriaceae species, P. shigelloides is also found in a wide range of hosts, including dogs,

The Aeromonas populations in 13 Swedish drinking water distribution systems, representing different treatments, were investigated. From each system, water samples were collected four times during the period from May to September 1994 from raw water and water after treatment and at two to five sites within the distribution system. In total, 220 water samples were collected. From samples containing presumptive Aeromonas, up to 32 colonies were analyzed by the PhenePlate Aeromonas (PhP-AE) system, which is a highly discriminating biochemical fingerprinting method. Selected isolates from different phenotypes (PhP types) were further identified by the API 20 NE system and by gas-liquid chromatography analysis of fatty acid methyl esters (FAMEs). Selected isolates were also assayed for their potential to produce hemolysin and cytotoxin and for their ability to adhere to human intestinal cells. In total, 117 water samples (53%) contained presumptive Aeromonas which numbered up to 10 6 CFU/100 ml in raw water and up to 750 CFU/100 ml in tap water. Among the 2,117 isolates that were subjected to typing by the PhP-AE system, more than 300 distinct PhP types were found, of which the majority occurred only sporadically. Raw (surface) water samples usually contained many different PhP types, showing high diversity indices (Di) (median Di ‫؍‬ 0.95). The Aeromonas populations in samples collected from within the distribution systems were less diverse (median Di ‫؍‬ 0.58) and were often dominated by one major PhP type that was found on several sampling occasions. Seventeen such major PhP types could be found and were represented in 1,037 isolates (49%). Identification by API 20 NE and FAME analysis revealed that most of the major PhP types were Aeromonas hydrophila or belonged to unidentified Aeromonas species. Hemolysin and cytotoxin production was observed in most major PhP types (representing 87 and 54% of the assayed isolates, respectively), and adherence was found in 89% of the isolates that produced cytotoxin. Thus, the data presented here show that although raw water may contain very diverse Aeromonas populations, the populations seemed to be remarkably stable within the studied water distribution systems, and that some potentially pathogenic Aeromonas strains could persist for several months in drinking water.

This pilot study was conducted to evaluate the occurrence of Clostridium difficile in samples of ground meat in Sweden. From April to September 2008, 82 meat samples were collected from randomly selected retail shops in Uppsala County (central Sweden). C. difficile was isolated from 2 (2.4%; both ground beef) of the 82 meat samples. No C. difficile was detected in pork, hamburger, sheep, poultry, or other type of meat samples. The two C. difficile isolates produced both toxin A and toxin B. These findings indicate that C. difficile might be present in ground meat samples in Sweden. However, further studies are necessary to confirm these preliminary data and to elucidate the public health significance of meat contamination by C. difficile in Sweden.