Clostridioides difficile ribotypes isolated from domestic environment and from patients in Bangladesh

Abstract

Clostridioides difficile infection (CDI) is an emerging but often understudied infectious disease in developing countries. This study was aimed to isolate and characterize C. difficile from shoe sole swabs and diarrheal patient's stool samples in Bangladesh. We collected 94 shoe sole swabs samples from urban communities in Dhaka and 208 diarrheal stool samples from hospitalized patients over a period of 4 months. Samples were incubated anaerobically for C. difficile growth, confirmed toxigenic, and PCR-ribotyped. Eleven of 94 (11.7%) shoe sole swabs and 4 of 208 (1.9%) stool samples were culture positive of which 9 shoe sole isolates were toxigenic. Six PCR ribotypes from the 9 toxigenic isolates were identified with ribotype F014-020 being the most common (n = 4; 44%). The recently identified ribotype 106 strain was also identified. To the best of our knowledge, this is the first report of C. difficile culture, isolation and characterization from environmental sources in Bangladesh.

Molecular epidemiology of toxigenic Clostridioides difficile isolates from hospitalized patients and the hospital environment in Dhaka, Bangladesh

“…Clinicians at these two hospitals were not testing for C. difficile until this study was conducted, highlighting the importance of this under-diagnosis. This finding contrasts the findings of a previous study which found no toxigenic C. difficile among 208 hospitalized diarrheal patients in Dhaka, Bangladesh [14]. As explained previously, the most likely explanation is that this study targeted patients who were at higher risk for CDI.…”

“…Eleven percent of hospital environmental samples were positive for toxigenic C. difficile. This is similar to the results of two previous studies which detected toxigenic C. difficile in 10% of community environmental samples from Dhaka, Bangladesh and 16.5% of hospital environmental samples from Houston, Texas [14,16]. As a whole, toxigenic isolates were recovered more commonly from patient care areas and areas proximal to patient beds, perhaps because these are the highest "traffic" area among patients and healthcare providers.…”

“…The current epidemiology of toxigenic C. difficile in Bangladesh is poorly understood as only two studies have reported C. difficile from Bangladesh [12,13]. Since then, a previous study demonstrated the presence of toxigenic C. difficile in shoe sole swab samples of urban communities in Dhaka, Bangladesh [14]. This previous work also tested 208 diarrheal patients who were admitted to the Dhaka hospital of the International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh (icddr,b) for toxigenic C. difficile.…”

Whole-genome sequencing links Clostridium (Clostridioides) difficile in a single hospital to diverse environmental sources in the community

“…In contrast to our study where the floor isolates were dominated by RT 010 (96.6%), the most common strain identified in their study was ST 42 (likely RT 106) which represented 21.4% of their isolates (Srinivasa et al, 2019). Meanwhile, the reported prevalence of C. difficile on shoe soles collected from households ranges from 11.7% in Bangladesh to 43% in Slovenia both of which are much less than the >86.7% from the shoes of veterinary staff and students in Poland (Islam et al, 2019; Janezic et al, 2018; Wojtacka et al, 2021). While RT 010 comprised up to 73.2% of our shoe isolates, other studies reported a greater diversity of RTs with their most common RT only comprising 20%, 24%, 36% and 40%–50% of the isolates in the United States, Poland, Bangladesh and Slovenia respectively (Alam et al, 2014; Islam et al, 2019; Janezic et al, 2018; Wojtacka et al, 2021).…”

High contamination rates of shoes of veterinarians, veterinary support staff and veterinary students with Clostridioides difficile spores

“…None of the reports has focused on the role of veterinary team on carriage the spores on their shoes, a sampling site that has recently gained much attention. First and subsequent reports from the United States and Bangladesh (Alam et al, 2014(Alam et al, , 2017Islam et al, 2019) showed varying loads of C. difficile on shoe swabs among all samples taken in the households and other urban areas. High level of shoe sole contamination was noted not only in households but also in hospitals in Slovenia (Janezic et al, 2018(Janezic et al, , 2020.…”