Recreational sandboxes for children and dogs can be a source of epidemic ribotypes of <i>Clostridium difficile</i>

Orden, Cristina; Neila, Carlos; Blanco, José L.; Álvarez‐Pérez, Sergio; Harmanus, Céline; Kuijper, Ed J.; García, Marta E.

doi:10.1111/zph.12374

Cited by 29 publications

(25 citation statements)

References 44 publications

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“…Studies addressing the presence of C. difficile in the natural environment are less numerous than those investigating the bacterium in foods and animals (Rodriguez et al, ). There are recent studies describing its presence in wastewater treatment plants or rivers (Moradigaravand et al, ; Zidaric et al, ), with some of them performed in soil farms (Bäverud et al, ) and in other rural areas (Janezic et al, ; Simango, ) or public environments (Al‐Saif & Brazier, ; Moono et al, ; Orden et al, ). Wastewater treatment plants are highly contaminated, with up to 96% of samples being positive (Romano et al, ; Xu, Weese, Flemming, Odumeru, & Warriner, ; Nikaeen, Aghili‐Dehnavi, Hssanzadeh, & Jalali, ).…”

Section: Discussionmentioning

confidence: 99%

“…In this context, C. difficile was reported to be present in 68% of positive samples from rivers near densely populated areas, with the same predominant ribotypes found in hospitals (Zidaric et al, ). Regarding public environments, such as parks and other playgrounds, the available data are not yet conclusive, since the reported prevalence varies from zero detection to 52% (Al‐Saif & Brazier, ; Orden et al, ). In this study, the overall prevalence found (40.2%) matched with the data reported previously from environmental samples.…”

Section: Discussionmentioning

confidence: 99%

“…Regarding dogs, C. difficile has been previously reported with a prevalence varying between 4.8% and 11.9% (Alvarez‐Perez, Blanco, Harmanus, Kuijper, & Garcia, ; Diniz et al, ). Sandboxes used by dogs have been also reported to be contaminated with a C. difficile rate of 60% (12 positive sandboxes out of 20 tested) (Orden et al, ). Regarding the results of our study, it is possible that dogs and are colonized by C. difficile after contact with soil, which is contaminated with spore levels of 50–100 cfu/g in busy areas.…”

Section: Discussionmentioning

confidence: 99%

“…In this context, some studies have previously investigated the presence of C. difficile in the environment, including soils and water samples (Janezic, Potocnik, Zidaric, & Rupnik, ). The bacterium has been recovered from soil samples taken from sand playgrounds and public gardens (Al‐Saif & Brazier, ; Moono, Lim, & Riley, ; Orden et al, ), from environmental soil samples and puddle water (Janezic et al, ), from rivers (Zidaric, Beigot, Lapajne, & Rupnik, ) and from rural environments in close contact with farm animals (Bäverud, Gustafsson, Franklin, Aspan, & Gunnarsson, ; Simango & Mwakurudza, ).…”

Section: Introductionmentioning

confidence: 99%

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Seasonality ofClostridium difficilein the natural environment

Rodríguez

Bouchafa

Soumillion

et al. 2019

Transbound Emerg Dis

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Clostridium difficile is considered the leading cause of antibiotic‐associated disease worldwide. In the past decade, a large number of studies have focused on identifying the main sources of contamination in order to elucidate the complete life cycle of the infection. Hospitals, animals and retail foods have been considered as potential vectors. However, the prevalence of C. difficile in these types of samples was found to be rather low, suggesting that other contamination routes must exist. This study explores the presence of C. difficile in the natural environment and the seasonal dynamics of the bacterium. C. difficile was isolated from a total of 45 samples out of 112 collected (40.2%) on 56 sampling points. A total of 17 points were positive only during the winter sampling (30.4%), 10 were positive only during the summer sampling (17.9%) and 9 sampling points (16.1%) were positive in both summer sampling and winter sampling. Spore counts in soil samples ranged between 50 and 250 cfu/g for 24.4% of the positive samples, with the highest concentrations detected in samples collected in the forest during winter campaign (200–250 cfu/g). A total of 17 different PCR ribotypes were identified, and 15 of them had the genes coding for toxins A and B. Most of those ribotypes had not previously been found or had been isolated only sporadically (<1% of samples) from hospitals in Belgium. Regarding antimicrobial susceptibility, most of the resistant strains were found during the summer campaign. These findings bear out that C. difficile is present in the natural environment, where the bacterium undergoes seasonal variations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Seasonality ofClostridium difficilein the natural environment

Rodríguez

Bouchafa

Soumillion

et al. 2019

Transbound Emerg Dis

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“…For those with no exposure to HA sources of infection, a potential source of CA-CDI could be environmental exposures, including food, compost, animals, and public sandboxes; over 50% of samples from public sandboxes in a Madrid study were positive for C. difficile, and seven of eight toxigenic samples were epidemic RTs 014 or 106. 47 The RT/strain of C. difficile may vary between HA-CDI and CA-CDI as well. 45 In efforts to identify modifiable risk factors and provide risk stratification, recent research efforts have focused on concomitant medication use, as well as identifying specific strains, and RTs of C. difficile.…”

Section: Recurrent CDImentioning

confidence: 99%

Clostridium difficile Infection: An Epidemiology Update

Roo

Regenbogen

2020

Clinics in Colon and Rectal Surgery

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Clostridium (reclassified as “Clostridioides”) difficile infection (CDI) is a healthcare-associated infection and significant source of potentially preventable morbidity, recurrence, and death, particularly among hospitalized older adults. Additional risk factors include antibiotic use and severe underlying illness. The increasing prevalence of community-associated CDI is gaining recognition as a novel source of morbidity in previously healthy patients. Even after recovery from initial infection, patients remain at risk for recurrence or reinfection with a new strain. Some pharmaco-epidemiologic studies have suggested an increased risk associated with proton pump inhibitors and protective effect from statins, but these findings have not been uniformly reproduced in all studies. Certain ribotypes of C. difficile, including the BI/NAP1/027, 106, and 018, are associated with increased antibiotic resistance and potential for higher morbidity and mortality. CDI remains a high-morbidity healthcare-associated infection, and better understanding of ribotypes and medication risk factors could help to target treatment, particularly for patients with high recurrence risk.

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Association Between Environmental Factors and Toxigenic Clostridioides difficile Carriage at Hospital Admission

et al. 2020

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IMPORTANCE Clostridioides difficile infection is the most frequent health care-associated infection in the United States. However, exposure to this organism might occur outside the health care setting. OBJECTIVE To examine whether exposure to environmental factors, such as livestock farms, is associated with a higher probability of being colonized with C difficile at hospital admission. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was conducted from May 1, 2017, to June 30, 2018, at a teaching-affiliated hospital in Milwaukee, Wisconsin. All consecutive patients underwent C difficile screening using a nucleic acid amplification test at hospital admission. Data analyses were performed from July 2018 to October 2019. EXPOSURES The distances from patient residence to the nearest livestock farms, meat processing plants, raw materials services, and sewage facilities were measured in addition to risk factors previously evaluated in other studies. MAIN OUTCOMES AND MEASURES The main outcome was a positive result on C difficile screening tests performed within 72 hours of hospital admission. RESULTS A total of 3043 patients admitted to the hospital were included in the final analysis. Of those, 1564 (51.4%) were women and 2074 (68.9%) were white, with a mean (SD) age of 62.0 (15.9) years; 978 patients (32.1%) were admitted to hematology-oncology units. At first admission, 318 patients (10.4%) were detected through testing as C difficile carriers. Multivariable logistic regression analyses were performed on a stratified sample of patients based on hematology-oncology admission status. These analyses indicated that although patients admitted to hematology-oncology units were 35% more likely to be colonized with C difficile, no significant association existed between their sociodemographic and economic characteristics or health care and environmental exposures and the likelihood of a positive C difficile test result. In contrast, among patients admitted to non-hematology-oncology units, comorbidities increased the likelihood for colonization by more than 4 times; women had 60% greater colonization than men, and a history of recent hospitalization (ie, within the preceding 6 months) increased the likelihood of colonization by 70%. Residential proximity to livestock farms were all significantly associated with a higher likelihood of a positive C difficile test result. Residential proximity to livestock farms more than doubled the probability of C difficile colonization in patients admitted to non-hematology-oncology units. CONCLUSIONS AND RELEVANCE A shorter distance between residence and livestock farms was associated with C difficile colonization. Knowledge of the epidemiology of C difficile in the community (continued) Key Points Question Is an individual's location of residence associated with asymptomatic carriage of toxigenic Clostridiodes difficile? Findings In this cohort study of 3043 adult participants admitted to the hospital, patients who lived closer to livestock farms had a higher likelihood...

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Recreational sandboxes for children and dogs can be a source of epidemic ribotypes of Clostridium difficile

Cited by 29 publications

References 44 publications

Seasonality ofClostridium difficilein the natural environment

Seasonality ofClostridium difficilein the natural environment

Clostridium difficile Infection: An Epidemiology Update

Association Between Environmental Factors and Toxigenic Clostridioides difficile Carriage at Hospital Admission

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