High prevalence of<i>Clostridium difficile</i>on retail root vegetables, Western Australia

Lim, Su Chen; Foster, Niki F.; Elliott, Briony; Riley, Thomas V.

doi:10.1111/jam.13653

Cited by 58 publications

(64 citation statements)

References 30 publications

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“…Of the root vegetables we tested (carrot, parsley and beetroot), only a single parsley sample was contaminated with C. difficile. An Australian study that tested organic root vegetables reported much higher positivity rates; 22.2% for beetroot, 5.6% for onions and 5.3% for carrots [20]. The vegetable reported by us and others to have a very high contamination rate (from 28.0% to up to 55.6%) is the potato [20,21], but potatoes were not included in the Slovenian food surveillance programme as these data were not available when the programme was started.…”

Section: Discussionmentioning

confidence: 85%

“…Food studies have mainly focused on meat and meat products; however, raw and ready-to-eat vegetables, seafood and milk can also contain C. difficile [10,11,16]. Most of the reported prevalence rates vary from not detected to 12.5% in meat and 7.5% in vegetables [10,11,17], but can rise above 50.0% in seafood and root vegetables [18][19][20][21]. As with animal strains, PCR ribotypes of food isolates can also overlap with human PCR ribotypes and can be genetically undistinguishable from human isolates by MLVA, a method with higher discriminatory power than PCR ribotyping [16].…”

Section: Introductionmentioning

confidence: 99%

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Clostridioides difficile in national food surveillance, Slovenia, 2015 to 2017

et al. 2020

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Background: Clostridioides difficile is an important human and animal intestinal pathogen. Because of increasing indications of an association between C. difficile and food, in 2015, the Administration of the Republic of Slovenia for Food Safety, Veterinary Sector and Plant Protection (UVHVVR) included C. difficile in its national food surveillance. Aim: We aim to report the results and experience with a nationwide and longterm testing of food for C. difficile as a part of a regular national food surveillance programme. Methods: Retail minced meat and meat preparations (beef, pork and poultry) were sampled within a three-year period, 2015 to 2017. Selected raw retail vegetables, leaf salads and root vegetables, and ready-to-eat salads were only sampled during 2016 and 2017. Seafood was only sampled in 2017. Results: Altogether, 434 samples were tested, with 12 of 336 (3.6%) meat samples and 6 of 98 (6.1%) raw vegetables contaminated with C. difficile. Twelve of 18 recovered food isolates were toxigenic (toxinotypes 0, III, V, XII). The isolates belonged to 13 different PCR ribotypes, 001 being most common (5 isolates). Several food types with an increased potential of being contaminated with C. difficile were detected by surveillance. Conclusion: The three-year C. difficile testing within the national food surveillance revealed a low proportion of C. difficile-contaminated food and high genotype variability. Because the risk of C. difficile infection associated with C. difficile-contaminated food is unknown, no measures were recommended in the case of positive results.

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Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Clostridioides difficile in national food surveillance, Slovenia, 2015 to 2017

et al. 2020

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“…https://doi.org/10.1101/19012450 doi: medRxiv preprint . Contextualization of food items tested in America, 6,18,19,34,35, , Europe, 23, Asia, [89][90][91][92][93][94][95][96][97][98][99][100][101][102][103] Africa, [104][105][106][107][108][109] and Oceania, 20,110,111 . For a historic narrative see is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.…”

Section: Discussionmentioning

confidence: 99%

Global and Historical Distribution ofClostridioides difficilein the Human Diet (1981-2019): Systematic Review and Meta-Analysis of 21886 Samples Reveal Sources of Heterogeneity, High-Risk Foods, and Unexpected Higher Prevalence Towards the Tropic

Rodriguez-Palacios

Shah

et al. 2019

Preprint

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Clostridioides difficile (CD) is a spore-forming bacterium that causes life-threatening intestinal infections in humans. Although formerly regarded as exclusively nosocomial, there is increasing genomic evidence that person-to-person transmission accounts for only <25% of cases, supporting the culture-based hypothesis that foods may be routine sources of CD-spore ingestion in humans. To synthesize the evidence on the risk of CD exposure via foods, we conducted a systematic review and meta-analysis of studies reporting the culture prevalence of CD in foods between January 1981 and November 2019. Meta-analyses, risk-ratio estimates, and meta-regression were used to estimate weighed-prevalence across studies and food types to identify laboratory and geographical sources of heterogeneity. In total, 21,886 food samples were tested for CD between 1981 and 2019 (232 food-sample-sets; 79 studies; 25 countries). Culture methodology, sample size and type, region, and latitude were significant sources of heterogeneity (p<0.05). Although non-strictly-anaerobic methods were reported in some studies, and we confirmed experimentally that improper anaerobiosis of media/sample-handling affects CD recovery in agar (Fisher, p<0.01), most studies (>72%) employed the same (one-of-six) culture strategy. Because the prevalence was also meta-analytically similar across six culture strategies reported, all studies were integrated using three meta-analytical methods. At the study level (n=79), the four-decade global cumulative-prevalence of CD in the human diet was 4.1% (95%CI=-3.71, 11.91). At the food-set level (n=232), the weighted prevalence ranged between 4.5% (95%CI=3-6%; all studies) and 8% (95%CI=7-8%; only CD-positive-studies). Risk-ratio ranking and meta-regression showed that milk was the least likely source of CD, while seafood, leafy green vegetables, pork, and poultry carried higher risks (p<0.05). Across regions, the risk of CD in foods for foodborne exposure reproducibly decreased with Earth latitude (p<0.001). In conclusion, CD in the human diet is a global nonrandom-source of foodborne exposure that occurs independently of laboratory culture methods, across regions, and at variable level depending on food type and latitude. The latitudinal trend (high CD-food-prevalence towards tropic) is inverse to the epidemiological observations of CD-infections (frequent in temperate regions). Findings suggests the plausible hypothesis that ecologically-richer microbiomes in the tropic might protect against intestinal CD colonization/infections despite CD ingestion.

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“…Since water treatment and composting does not necessarily destroy C. difficile spores, C. difficile can be readily isolated from vegetables grown in these environments. 84 The extent to which C. difficile spores contaminate our food supply remains unclear. Numerous studies have isolated C. difficile from raw meat, lettuce, and shellfish 85 but no instances of food-borne transmission of C. difficile have been reported.…”

Section: Difficile Can Be Transmitted Between Animals and Humans Bmentioning

confidence: 99%

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

Shen

2020

Clinics in Colon and Rectal Surgery

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The Gram-positive, spore-forming bacterium, Clostridioides difficile is the leading cause of healthcare-associated infections in the United States, although it also causes a significant number of community-acquired infections. C. difficile infections, which range in severity from mild diarrhea to toxic megacolon, cost more to treat than matched infections, with an annual treatment cost of approximately $6 billion for almost half-a-million infections. These high–treatment costs are due to the high rates of C. difficile disease recurrence (>20%) and necessity for special disinfection measures. These complications arise in part because C. difficile makes metabolically dormant spores, which are the major infectious particle of this obligate anaerobe. These seemingly inanimate life forms are inert to antibiotics, resistant to commonly used disinfectants, readily disseminated, and capable of surviving in the environment for a long period of time. However, upon sensing specific bile salts in the vertebrate gut, C. difficile spores transform back into the vegetative cells that are responsible for causing disease. This review discusses how spores are ideal vectors for disease transmission and how antibiotics modulate this process. We also describe the resistance properties of spores and how they create challenges eradicating spores, as well as promote their spread. Lastly, environmental reservoirs of C. difficile spores and strategies for destroying them particularly in health care environments will be discussed.

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High prevalence ofClostridium difficileon retail root vegetables, Western Australia

Abstract: This study enhances knowledge of possible sources of C. difficile in the Australian community, outside the hospital setting.

Cited by 58 publications

References 30 publications

Clostridioides difficile in national food surveillance, Slovenia, 2015 to 2017

Clostridioides difficile in national food surveillance, Slovenia, 2015 to 2017

Global and Historical Distribution ofClostridioides difficilein the Human Diet (1981-2019): Systematic Review and Meta-Analysis of 21886 Samples Reveal Sources of Heterogeneity, High-Risk Foods, and Unexpected Higher Prevalence Towards the Tropic

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

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