Clostridium difficile in Asia: Opportunities for One Health Management

Abstract

Clostridium difficile is a ubiquitous spore-forming bacterium which causes toxin-mediated diarrhoea and colitis in people whose gut microflora has been depleted by antimicrobial use, so it is a predominantly healthcare-associated disease. However, there are many One Health implications to C. difficile, given high colonisation rates in food production animals, contamination of outdoor environments by use of contaminated animal manure, increasing incidence of community-associated C. difficile infection (CDI), and demonstration of clonal groups of C. difficile shared between human clinical cases and food animals. In Asia, the epidemiology of CDI is not well understood given poor testing practices in many countries. The growing middle-class populations of Asia are presenting increasing demands for meat, thus production farming, particularly of pigs, chicken and cattle, is rapidly expanding in Asian countries. Few reports on C. difficile colonisation among production animals in Asia exist, but those that do show high prevalence rates, and possible importation of European strains of C. difficile like ribotype 078. This review summarises our current understanding of the One Health aspects of the epidemiology of CDI in Asia.

Clostridioides difficile in Calves in Central Italy: Prevalence, Molecular Typing, Antimicrobial Susceptibility and Association with Antibiotic Administration

“…In our study, RT-126, -033, -078 and -010 turned out to be the most common ribotypes, each isolated from more than one farm. This finding is in accordance with what we have reported in calves in Italy [ 17 ] and is consistent with the literature, which indicates that these ribotypes as the most common ones in neonatal calves and piglets in Europe and Asia [ 15 , 24 , 34 , 40 , 41 , 54 , 55 , 56 , 57 , 58 ].…”

Different molecular characteristics and antimicrobial resistance profiles of Clostridium difficile in the Asia-Pacific region

“…Consequently, our study demonstrated that multiple C. difficile genotypes are circulating in the Asia-Pacific region and exhibit unique molecular characteristics at each site. C. difficile isolates with the same STs may be transmitted between different regions through food trade and travel in the Asia-Pacific region as previously reported [26]. Further studies focusing on analysis of whole-genome sequences combined with epidemiological data are required to investigate genetic relationship between different sites for the same STs.…”

“…In recent years, an increasing number of studies has evaluated CDI epidemiology in Asia [12,26]. These have suggested that CDI is a very much under-recognized problem in Asia owing to poor clinical awareness among physicians [12].…”

Persistence of spore-formingClostridium(Clostridioides)difficilethrough wastewater treatment plants in Western Australia

“…Due to RT039 being non-toxigenic, it is usually not reported from human clinical samples (53, 54), however, it is a relatively common RT found in the environment in Australia although greater resistance to any antimicrobial agents has never been reported (55). Non-toxigenic C. difficile strains are highly prevalent in Asia and many of these strains are resistant to multiple antimicrobials, possibly due to inappropriate antimicrobial use in the region (56). These C. difficile RT039 strains may be of Asian origin and could have either acquired AMR genes via horizontal gene transfer from other microbes in the host intestine or from the consortium of pathogenic/commensal microbes in WWTPs.…”