Isolation of toxigenic Clostridium difficile from ready-to-eat salads by multiplex polymerase chain reaction in Isfahan, Iran

Yamoudy, Mahire; Mirlohi, Maryam; Isfahani, Bahram Nasr; Jalali, Mohammad; Esfandiari, Zahra; Hosseini, Nasrin

doi:10.4103/2277-9175.156650

Cited by 12 publications

(5 citation statements)

References 32 publications

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“…Eckert et al [31] reported a similar prevalence of C. difficile in salads purchased from retail stores in France (3.3%). A slightly lower prevalence was reported in lettuce (1.9%) in an Italian study by Primavilla et al [34], but higher levels have also been found in salad leaves and ready-to-eat salads in Iran (5.6%) [36], in Ireland (6%) [24] and in Scotland (7.5%) [35]. Root vegetables are more frequently contaminated with C. difficile (10-75%) than leafy greens [31,33,35,74], most likely due to soil residues [74,75].…”

Section: Prevalence Of C Difficilementioning

confidence: 79%

“…Thus, crops including vegetables are inevitably contaminated, resulting in a potential risk of infection for consumers [27][28][29][30]. Several studies have reported the detection of C. difficile in vegetables at retail [31][32][33], including salad leaves [24,34] and ready-to-eat (RTE) salads [31,35,36]. The C. difficile ribotypes identified in these studies include RT056, which has been associated with human illness [37].…”

Section: Introductionmentioning

confidence: 99%

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Detection and Genomic Characterisation of Clostridioides difficile from Spinach Fields

et al. 2022

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Despite an increased incidence of Clostridioides difficile infections, data on the reservoirs and dissemination routes of this bacterium are limited. This study examined the prevalence and characteristics of C. difficile isolates in spinach fields. C. difficile was detected in 2/60 (3.3%) of spinach and 6/60 (10%) of soil samples using culture-based techniques. Whole genome sequencing (WGS) analysis identified the spinach isolates as belonging to the hypervirulent clade 5, sequence type (ST) 11, ribotypes (RT) 078 and 126 and carried the genes encoding toxins A, B and CDT. The soil isolates belonged to clade 1 with different toxigenic ST/RT (ST19/RT614, ST12/RT003, ST46/RT087, ST16/RT050, ST49/RT014/0) strains and one non-toxigenic ST79/RT511 strain. Antimicrobial resistance to erythromycin (one spinach isolate), rifampicin (two soil isolates), clindamycin (one soil isolate), both moxifloxacin and rifampicin (one soil isolate), and multi-drug resistance to erythromycin, vancomycin and rifampicin (two soil isolates) were observed using the E test, although a broader range of resistance genes were detected using WGS. Although the sample size was limited, our results demonstrate the presence of C. difficile in horticulture and provide further evidence that there are multiple sources and dissemination routes for these bacteria.

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Section: Prevalence Of C Difficilementioning

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Detection and Genomic Characterisation of Clostridioides difficile from Spinach Fields

et al. 2022

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“…From 1,939 studies identified, 79 fulfilled the inclusion criteria for meta-analysis, involving >231 authors and 25 countries over the past 37 years. The list of studies in chronological order from North America (10,16,17,, Europe (21,, Asia (80)(81)(82)(83)(84)(85)(86)(87)(88)(89)(90)(91)(92)(93)(94)(95)(96), Africa (97)(98)(99)(100)(101)(102), Oceania (18, 103) (Australia/New Zealand) and Latin American (104,105) is presented in Table 1 (10, 16-18, 21, 30-32, 34-61, 63-78, 80-93, 96-110). The majority of studies, 92.4% (73 of 79 studies) since 2007, encompass 96.4% of all food samples tested (over the last 12 years) making this analysis current and relevant to the modern concerns of food transmission of CD via the food supply.…”

Section: Global Distribution Of Studies Reporting C Difficile In Foomentioning

confidence: 99%

Global and Historical Distribution of Clostridioides difficile in the Human Diet (1981–2019): Systematic Review and Meta-Analysis of 21886 Samples Reveal Sources of Heterogeneity, High-Risk Foods, and Unexpected Higher Prevalence Toward the Tropic

Rodriguez-Palacios

Shah

et al. 2020

Front. Med.

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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, 21886 food samples were tested for CD between 1981 and 2019 (96.4%, n = 21084, 2007-2019; 232 food-sample-sets; 79 studies; 25 countries). Culture methodology, sample size and type, region, and latitude were 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, mean 12.9 g/sample, similar across regions p > 0.2; 95%CI = 9.7-16.2), the weighted prevalence ranged between Rodriguez-Palacios et al. Clostridium difficile in Human Diet 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 non-random-source of foodborne exposure that occurs independently of laboratory culture methods, across regions, and at a variable level depending on food type and latitude. The latitudinal trend (high CD-food-prevalence toward tropic) is unexpectedly inverse to the epidemiological observations of CD-infections in humans (frequent in temperate regions). Findings suggest the plausible hypothesis that ecologically-richer microbiomes in the tropic might protect against intestinal CD colonization/infections despite CD ingestion.

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“…In addition, several studies demonstrate the presence of C. difficile in several foods, including meat, ready-to-eat salads, and raw vegetables (such as cucumber, onions, carrots, etc.) [128][129][130][131]. Given that C. difficile is present in water, animal feces, and livestock manure compost, it could easily be transferred to vegetables.…”

Section: Microorganismsmentioning

confidence: 99%

One Health Perspectives on Food Safety in Minimally Processed Vegetables and Fruits: From Farm to Fork

Santos,

Grácio,

Silva

et al. 2023

Microorganisms

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While food markets and food production chains are experiencing exponential growth, global attention to food safety is steadily increasing. This is particularly crucial for ready-to-eat products such as fresh-cut salads and fruits, as these items are consumed raw without prior heat treatment, making the presence of pathogenic microorganisms quite frequent. Moreover, many studies on foodborne illnesses associated with these foods often overlook the transmission links from the initial contamination source. The prevention and control of the dissemination of foodborne pathogens should be approached holistically, involving agricultural production, processing, transport, food production, and extending to final consumption, all while adopting a One Health perspective. In this context, our objective is to compile available information on the challenges related to microbiological contamination in minimally handled fruits and vegetables. This includes major reported outbreaks, specific bacterial strains, and associated statistics throughout the production chain. We address the sources of contamination at each stage, along with issues related to food manipulation and disinfection. Additionally, we provide potential solutions to promote a healthier approach to fresh-cut fruits and vegetables. This information will be valuable for both researchers and food producers, particularly those focused on ensuring food safety and quality.

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Isolation of toxigenic Clostridium difficile from ready-to-eat salads by multiplex polymerase chain reaction in Isfahan, Iran

Cited by 12 publications

References 32 publications

Detection and Genomic Characterisation of Clostridioides difficile from Spinach Fields

Detection and Genomic Characterisation of Clostridioides difficile from Spinach Fields

Global and Historical Distribution of Clostridioides difficile in the Human Diet (1981–2019): Systematic Review and Meta-Analysis of 21886 Samples Reveal Sources of Heterogeneity, High-Risk Foods, and Unexpected Higher Prevalence Toward the Tropic

One Health Perspectives on Food Safety in Minimally Processed Vegetables and Fruits: From Farm to Fork

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