Community Environmental Contamination of Toxigenic Clostridium difficile

Alam, Mohammad Jahangir; Walk, Seth T.; Endres, Bradley T.; Bassères, Eugénie; Khaleduzzaman, Mohammed; Amadio, Jonathan; Musick, William L.; Christensen, Jennifer L.; Kuo, Julie; Atmar, Robert L.; Garey, Kevin W.

doi:10.1093/ofid/ofx018

Cited by 46 publications

(42 citation statements)

References 24 publications

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“…Clostridium difficile is widespread outside hospitals and can be isolated from nearly any environment (Alam et al., ). The importance of non‐hospital reservoirs was demonstrated in a large surveillance study showing that almost half (45%) of clinical C. difficile isolates were not consistent with the nosocomial acquisition and that a large environmental reservoir is the most likely source of these isolates (Eyre et al., ).…”

Section: Discussionmentioning

confidence: 99%

Dissemination of Clostridium difficile spores between environment and households: Dog paws and shoes

Janežič

Mlakar

Rupnik

2018

Zoonoses and Public Health

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Clostridium difficile is an anaerobic, spore-forming bacterium that causes intestinal infections. Although C. difficile is still predominantly considered as a nosocomial pathogen, there has been an increase in the number of community-associated infections. Since C. difficile is ubiquitous and can be isolated from nearly any environment, one of the possibilities for community acquisition could be exposure to spores in the domestic environment. The aim of this study was to evaluate the presence of C. difficile spores on shoes, slippers and on dog paws and to explore the importance of these surfaces as vectors for the dissemination of C. difficile in a domestic environment. Overall, C. difficile was present in 14 (70%) of 20 households and in 31 of 90 (34%) collected samples. Shoes and slippers had the highest positivity rates, 19 of 44 (43%) and 6 of 21 (28%), respectively, followed by dog paws 6 of 25 (24%). Thirteen C. difficilePCR ribotypes were identified with half of the isolates belonging to ribotype 014/020, which is the predominant type circulating in human population and is also commonly found in the environment (e.g. soil and water) in Slovenia. In three households, identical PCR ribotypes were found on dog paws, shoes and slippers. To understand the fine-scale genetic relatedness of these isolates, we sequenced the genomes. Low level of single nucleotide variant (SNV) differences between isolates from the same households, consistent with a recent transmission from a common source, were seen for isolates of PCR ribotype 014/020 but not for PCR ribotype 010. Our results suggest that shoe soles and dog paws could serve for the dissemination of C. difficile spores between households and environment and could contribute to community-relevant sources for C. difficile infection in humans.

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Section: Discussionmentioning

confidence: 99%

Dissemination of Clostridium difficile spores between environment and households: Dog paws and shoes

Janežič

Mlakar

Rupnik

2018

Zoonoses and Public Health

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“…Characteristic C. difficile colonies were tested using latex agglutination reagent (Oxoid, Hampshire, England) and presence of triose phosphate isomerase and toxin genes was determined using multiplex PCR [22]. Fluorescent PCR ribotyping was performed as previously described [23]. This technique does not distinguish between all ribotypes; therefore, some ribotypes are reported as combined (e.g.…”

Section: Collection Culture and Typingmentioning

confidence: 99%

PCR ribotypes of Clostridioides difficile across Texas from 2011 to 2018 including emergence of ribotype 255

Gonzales-Luna

Carlson

Dotson

et al. 2020

Emerging Microbes & Infections

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Clostridioides difficile infection (CDI) is the most prevalent healthcare-associated infection in the United States and carries a significant healthcare system burden. As part of an ongoing, active surveillance system of C. difficile throughout Texas, the objective of this study was to assess changes in C. difficile ribotypes of clinical isolates obtained from hospitalized patients in Texas over the past seven years. Fifty hospitals located in Texas, USA sent C. difficile positive stool specimens to a centralized laboratory for PCR ribotyping and toxin characterization between 2011 and 2018. Data collected included specimen collection date, patient age, and sex. Strain genotypes were compiled, and changes in ribotype distribution over time were assessed. Overall, 7796 samples were ribotyped from predominately female patients (58.4%) aged 62 ± 19 years. Samples were obtained from all geographic regions of Texas including Houston/Southwest region (n = 5129; 85%), Dallas/North Texas (n = 579, 9.6%), Central Texas (n = 164; 2.7%), and South Texas (n = 162; 2.6%). The 10 most common ribotypes comprised 73% of all isolates tested during the study period. The most common ribotypes were 027 (17.5%), followed by 014-020 (16.1%), 106 (11.6%), and 002 (9.1%). The prevalence of ribotypes 027, 001, and 078-126 declined significantly over time, while ribotypes 106 and 054 increased in prevalence (P < 0.001). Furthermore, the emergence of a novel ribotype 255 strain was observed. Differences in ribotype distribution were also noted based on age and geographic distribution (P < 0.001, each). This seven-year study demonstrated changing molecular epidemiology of C. difficile in Texas, including the emergence of a novel ribotype 255.

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“…We have previously demonstrated that toxigenic C. difficile spores are present in the healthcare and non–healthcare environments, including shoe bottoms. 2 It is possible that sites that underwent terminal cleaning became recontaminated from another source. This example demonstrates the value of typing in addition to culture to demonstrate removal of the original clone.…”

Section: Discussionmentioning

confidence: 99%

“…2 From each sample, 10mL broth culture was centrifuged to concentrate the cells with the resulting pellet suspended in 100 μL of normal saline (0.85% NaCl), plated onto cycloserine cefoxitin fructose agar (CCFA, Anaerobic Systems, Morgan Hill, CA), and incubated anaerobically at 37°C for 40–48 hours (Forma Anaerobic System, Mode 1025/1029). Suspected colonies were tested using latex agglutination reagent (Oxoid, Hampshire, UK).…”

Section: Methodsmentioning

confidence: 99%

“…Previously, our group showed that C. difficile can be isolated from areas within and outside of the hospital regardless of proximity to a CDI patient. 2 Thus, prevention and control of outbreaks or hyperendemic CDI likely requires an in-depth knowledge of the molecular epidemiology of the strains throughout the continuum of care. Thus, careful monitoring of patients outside of the acute-care hospital presents an important challenge for infection control.…”

mentioning

confidence: 99%

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Environmental transmission of Clostridioides difficile ribotype 027 at a long-term care facility; an outbreak investigation guided by whole genome sequencing

Endres

Dotson

Poblete

et al. 2018

Infect. Control Hosp. Epidemiol.

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Objective: This article describes a CDI outbreak in a long-term care (LTC) facility that used molecular typing techniques and whole-genome sequencing to identify widespread dissemination of the clonal strain in the environment which was successfully removed after terminal cleaning. Setting: This study was conducted in a long-term care facility in Texas. Methods: A recently hospitalized LTC patient was diagnosed with CDI followed shortly thereafter by 7 subsequent CDI cases. A stool specimen was obtained from each patient for culturing and typing. An environmental point-prevalence study of the facility was conducted before and after terminal cleaning of the facility to assess environmental contamination. Cultured isolates were typed using ribotyping, multilocus variant analysis, and whole-genome sequencing. Results: Stool samples were available for 5 of 8 patients; of these specimens, 4 grew toxigenic C. difficile ribotype 027. Of 50 environmental swab samples collected throughout the facility prior to the facility-wide terminal cleaning, 19 (38%) grew toxigenic C. difficile (most commonly ribotype 027, 79%). The terminal cleaning was effective at reducing C. difficile spores in the environment and at eradicating the ribotype 027 strain (P < .001). Using multilocus variance analysis and whole-genome sequencing, clinical and environmental strains were highly related and, in some cases, were identical. Conclusion: Using molecular typing techniques, we demonstrated reduced environmental contamination with toxigenic C. difficile and the eradication of a ribotype 027 clone. These techniques may help direct infection control efforts and decrease the burden of CDI in the healthcare system.

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Community Environmental Contamination of Toxigenic Clostridium difficile

Cited by 46 publications

References 24 publications

Dissemination of Clostridium difficile spores between environment and households: Dog paws and shoes

Dissemination of Clostridium difficile spores between environment and households: Dog paws and shoes

PCR ribotypes of Clostridioides difficile across Texas from 2011 to 2018 including emergence of ribotype 255

Environmental transmission of Clostridioides difficile ribotype 027 at a long-term care facility; an outbreak investigation guided by whole genome sequencing

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