Possible contribution of shoes to Clostridioides difficile transmission within hospitals

Janežič, Sandra; Blažević, Ines; Eyre, David W; Kevorkijan, Božena Kotnik; Remec, Tatjana; Rupnik, Maja

doi:10.1016/j.cmi.2020.11.001

Cited by 6 publications

(9 citation statements)

References 5 publications

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“…We believe that the increased usage of antibiotics, (29,30). Patients hospitalized in the urology hospital are also burdened with the diseases of the urinary or genitourinary system, requiring surgical treatment or a procedure to permanently maintain catheters in the urinary system (indwelling catheters, DJ catheters, nephrostomies).…”

Section: Discussionmentioning

confidence: 99%

Clostridium perfringens Spores in Urology Hospital

Gofron

Szarek

Aptekorz

et al. 2022

Jundishapur J Microbiol

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Background: Clostridium spp. spores are resistant to many factors, including alcohol-based disinfectants. The presence of clostridial spores in a hospital environment may lead to infection outbreaks among patients and health care workers. Objective: This study aimed to detect clostridial spores in aurology hospital using C diff Banana Broth™ and assess the antibiotic sensitivity and toxinotypes of isolates. Methods: After diagnosing COVID-19 in medical staff and closing an 86-bed urology hospital in 2020 for H2O2 fogging, 58 swabs from the hospital environment were inoculated to C diff Banana Broth™, incubated at 37°C for 14 days, checked daily, and positive broths were sub-cultured anaerobically for 48 h at 37°C. After identification, multiplex PCR (mPCR) was performed for Clostridium perfringens, C. difficile toxin genes, and MIC determination. Results: In this study, 16.58 (~ 28%) strains of Clostridium spp. were cultured: 11 - C. perfringens, 2 - C. baratii, and 1 each of C. paraputrificum, C. difficile, and C. clostridioforme. Moreover, C. difficile produced all toxins, and 11 C. perfringens consisted of 1 cpa, 7 cpb2, 2 cpiA, and 1 cpb gene-positive. All isolates were sensitive to metronidazole, vancomycin, moxifloxacin, penicillin/tazobactam, and rifampicin. Two out of the 11 C. perfringens strains were resistant to erythromycin and clindamycin. Conclusions: Regardless of the performed H2O2 fogging, antibiotic-resistant, toxigenic strains of C. perfringens (69%) obtained from the urology hospital environment were cultured using C diff Banana Broth™, indicating the need to develop the necessary sanitary and epidemiological procedures in this hospital.

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Section: Discussionmentioning

confidence: 99%

Clostridium perfringens Spores in Urology Hospital

Gofron

Szarek

Aptekorz

et al. 2022

Jundishapur J Microbiol

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“… 2014 ) to 43% (Janezic et al., 2018 ). In contrast, in hospital environment the footwear positivity rate increases to 62%, but differed between two hospitals and between wards (Janezic et al., 2020 ). High positivity of shoe soles could imply the ongoing C. difficile outbreak, but the high PCR ribotype diversity did not confirm this.…”

Section: Discussionmentioning

confidence: 99%

“…First and subsequent reports from the United States and Bangladesh (Alam et al., 2014 , 2017 ; Islam et al., 2019 ) showed varying loads of C. difficile on shoe swabs among all samples taken in the households and other urban areas. High level of shoe sole contamination was noted not only in households but also in hospitals in Slovenia (Janezic et al., 2018 , 2020 ).…”

Section: Introductionmentioning

confidence: 99%

High contamination rates of shoes of veterinarians, veterinary support staff and veterinary students with Clostridioides difficile spores

Wojtacka

Wysok

Kocuvan

et al. 2021

Transbounding Emerging Dis

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Clostridioides difficile is often found in animals and their environment. However, not much has been reported on veterinary clinics environment in terms of the spore load, prevalence and PCR ribotype diversity. The aim of this study was to assess the prevalence of C. difficile on shoe soles of veterinarians, veterinary support staff and veterinary students at the Veterinary Faculty campus. Altogether, 50 shoe sole swabs were collected, and the positivity rates ranged from 86.7% in swabs from veterinarians to 100% in swabs from support staff and students. Non‐toxigenic and toxigenic strains representing toxinotypes 0, IV and XIX were isolated and distributed into 17 different PCR ribotypes, most common being 010, 014/020, SLO002 and 009. PCR ribotype 010 was the most prevalent and isolated from shoe soles sampled in 6/7 areas. Students' shoes had highest ribotype diversity (15/17 PCR ribotypes) but showed a low overlap with ribotype isolated from vets and support staff shoes. Veterinary students are likely the main vectors of C. difficile spores transmissions among veterinary teaching clinics and the hospital.

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“…Buchler et al demonstrated contamination in 17.8% of the soles of healthcare workers’ shoes with toxigenic strains of C. difficile linked epidemiologically and confirmed by whole genome sequencing in infected patients [ 20 ]. A high level of shoe sole contamination with C. difficile has also been observed in hospitals in Slovenia [ 21 , 22 ]. Several studies have also investigated the dynamics of transmission between shoe soles or floor surfaces and patient colonization, with most studies demonstrating the potential for colonization by aerosolization, direct contact, or indirect methods [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness Evaluation of a UV-C-Photoinactivator against Selected ESKAPE-E Pathogens

Rangel

Cabral

Lechuga

et al. 2022

IJERPH

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Healthcare-associated infections (HAI) worldwide includes infections by ESKAPE-E pathogens. Environmental surfaces and fomites are important components in HAI transmission dynamics, and shoe soles are vectors of HAI. Ultraviolet (UV) disinfection is an effective method to inactivate pathogenic microorganisms. In this study, we investigated whether the SANITECH UV-C shoe sole decontaminator equipment that provides germicidal UV-C radiation could effectively reduce this risk of different pathogens. Six standard strains and four clinical MDR strains in liquid and solid medium were exposed to a UV-C System at specific concentrations at other times. Bacterial inactivation (growth and cultivability) was investigated using colony counts and resazurin as metabolic indicators. SEM was performed to assess the membrane damage. Statistically significant reduction in cell viability for all ATCCs strains occurred after 10 s of exposure to the UV-C system, except for S. enterica, which only occurred at 20 s. The cell viability of P. aeruginosa (90.9%), E. faecalis and A. baumannii (85.3%), S. enterica (82.9%), E. coli (79.2%) and S. aureus (71.9%) was reduced considerably at 20 s. In colony count, after 12 s of UV-C exposure, all ATCC strains showed a 100% reduction in CFU counts, except for A. baumannii, which reduced by 97.7%. A substantial reduction of colonies above 3 log10 was observed at 12 and 20 s in all bacterial strains tested, except for A. baumannii ATCC 19606 (12 s). The exposure of ATCCs bacterial strains to the UV-C system for only 2 s was able to reduce 100% in the colony forming units (CFU) count in all ATCCs strains, S. aureus, P. aeruginosa, E. coli, A. baumannii, E. faecalis, except the S. enterica strain which had a statistically significant reduction of 99.7%. In ATCC strains, there was a substantial decrease in colonies after 4 s (sec) of exposure to the UV-C system, with a reduction ranging from 3.78–4.15 log10 CFU/mL. This reduction was observed in MDR/ESKAPE-E strains within 10 s, showing that UV-C could eliminate above 3.84 log10 CFU/mL. SEM showed a reduction of pili-like appendages after UV-C treatment in all strains except for E. coli (ATCC 25922). The Sanitech UV-C shoe sole decontaminator equipment from Astech Serv. and Fabrication Ltd. (Petrópolis, Brazil), effectively killed in vitro a series of ATCCs and MDR/ESKAPE-E bacteria of sanitary interest, commonly found in the hospital environment.

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Possible contribution of shoes to Clostridioides difficile transmission within hospitals

Cited by 6 publications

References 5 publications

Clostridium perfringens Spores in Urology Hospital

Clostridium perfringens Spores in Urology Hospital

High contamination rates of shoes of veterinarians, veterinary support staff and veterinary students with Clostridioides difficile spores

Effectiveness Evaluation of a UV-C-Photoinactivator against Selected ESKAPE-E Pathogens

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