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

Abstract

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.

Clostridium difficile beyond stools: dog nasal discharge as a possible new vector of bacterial transmission

“…C. difficile was isolated from the noses of dogs with a percentage of 19% by classical culture and after enrichment. The prevalence reported in adult dog paws and their households does not exceed 34% (Janezic et al., 2018). Therefore, the preliminary findings of this study indicate that animal nasal cavities merit further attention regarding the spread of C. difficile and the microbiota composition.…”

“…Recently, dogs and cats have attracted the attention of many researchers since pets are in continuous close contact with their owners and often share the same resting places at home (bedrooms, living rooms, kitchens). Previous studies have demonstrated that shoes, slippers and dog paws could spread C. difficile spores among the environment, humans and animals (Janezic et al., 2018; Lefebvre and Weese, 2009). Most recently, a systematic large-scale survey was conducted for the first time to determine the occurrence of C. difficile in dogs and cats and their owners, and a bacterium prevalence of 3% was observed in faecal samples from both pets and humans, with PCR-ribotype 014 as the predominant type (Rabold et al., 2018).…”

Prevalence, Colonization, Epidemiology, and Public Health Significance of Clostridioides difficile in Companion Animals

“…A study conducted in Spain identified toxigenic C. difficile isolates in playground sandboxes that are unprotected from dogs, posing an additional public health risk to a vulnerable young population ( 96 ). Additionally, mechanical spread of C. difficile from houses to the community through shoe soles and dog paws have been reported ( 97 ).…”

Clostridioides difficile Spores: Bile Acid Sensors and Trojan Horses of Transmission

“…76 In a survey of sandboxes for children and dogs in Spain, C. difficile could be isolated from approximately 50% of these sandboxes, 77 and C. difficile was isolated from shoes and dog paws in approximately 20 to 40% of households surveyed in Slovenia. 11 The link between C. difficile colonization of farm animals with transmission to humans has been explored more fully. C. difficile is an important cause of neonatal enteritis in piglets, 52 and the location of pig farms and C. difficile ribotype 078 infections has been shown to overlap significantly in the Netherlands.…”