Spread and persistence of Clostridium difficile spores during and after cleaning with sporicidal disinfectants

Ali, Shanom; Moore, Ginny; Wilson, A.P.R.

doi:10.1016/j.jhin.2011.06.010

Cited by 33 publications

(22 citation statements)

References 7 publications

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“…Recent work demonstrated that C. difficile (ribotype 027) spores may persist on surfaces for up to 60 min, despite disinfection with a commercially available sporicide (22). The presence of residual disinfectant on surfaces over this period may negate the efficacy of a real-time sampling protocol.…”

Section: Discussionmentioning

confidence: 99%

A Novel Quantitative Sampling Technique for Detection and Monitoring of Clostridium difficile Contamination in the Clinical Environment

2015

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The horizontal transmission of Clostridium difficile in the hospital environment is difficult to establish. Current methods to detect C. difficile spores on surfaces are not quantitative, lack sensitivity, and are protracted. We propose a novel rapid method to detect and quantify C. difficile contamination on surfaces. Sponge swabbing was compared to contact plate sampling to assess the in vitro recovery of C. difficile ribotype 027 contamination (ϳ10 0 , 10 1 , or 10 2 CFU of spores) from test surfaces (a bed rail, a stainless steel sheet, or a polypropylene work surface). Sponge swab contents were concentrated by vacuum filtration, and the filter membrane was plated onto selective agar. The efficacy of each technique for the recovery of C. difficile from sites in the clinical environment that are touched at a high frequency was evaluated. Contact plates recovered 19 to 32% of the total contamination on test surfaces, whereas sponge swabs recovered 76 to 94% of the total contamination, and contact plates failed to detect C. difficile contamination below a detection C lostridium difficile infection (CDI) remains one of the most clinically important health care-associated infections and continues to burden health care services and finances (1, 2). The presentation of the disease can vary from mild diarrhea to severe colitis (3) and toxic dilatation that requires colectomy or may result in death. The use of proton pump inhibitors, residence in long-term-care facilities, and use of antibiotics are recognized risk factors (4, 5). However, the increasing incidence of communityacquired CDI suggests that other contributory factors may be responsible for the spread of the disease (6, 7). The horizontal transmission of CDI is implicated in patients with or without diarrhea, who may shed spores of C. difficile to contaminate their surrounding surfaces (8). Spores of C. difficile can persist on hospital surfaces for months (9), posing a risk of spreading to surfaces beyond the near patient environment, such as via the hands of patients, visitors, and health care workers (10).To reduce the risk of transmission, patients considered to be sources of CDI should be isolated upon presentation of symptoms of diarrhea, and an enhanced cleaning protocol should be implemented (11). Decontamination of surfaces in the clinical environment using a sporicide is recommended for C. difficile-positive cases only (11). However, patients may remain asymptomatic, even though they are excreting C. difficile (3), and will not prompt the implementation of infection control measures in the absence of diarrhea. Consequently, patients with asymptomatic cases of C. difficile disease may continue to contaminate the clinical environment unhindered unless a carrier status is diagnosed.Assessment of surfaces in the patient environment to monitor contamination levels and the persistence of C. difficile spores is not routinely performed. Current methods to sample surfaces for C. difficile contamination are not quantitative, have a low sensitivity, and req...

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Section: Discussionmentioning

confidence: 99%

A Novel Quantitative Sampling Technique for Detection and Monitoring of Clostridium difficile Contamination in the Clinical Environment

2015

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“…The spores of C. difficile are resistant to stomach acid, heat, and many commercial disinfectants used in hospitals (60). Following ingestion, exposure of the spores to bile salts in the small intestine triggers germination (61).…”

Section: Clostridium Difficilementioning

confidence: 99%

Practical Guidance for Clinical Microbiology Laboratories: Diagnosis of Bacterial Gastroenteritis

2015

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SUMMARY Bacterial gastroenteritis is a disease that is pervasive in both the developing and developed worlds. While for the most part bacterial gastroenteritis is self-limiting, identification of an etiological agent by bacterial stool culture is required for the management of patients with severe or prolonged diarrhea, symptoms consistent with invasive disease, or a history that may predict a complicated course of disease. Importantly, characterization of bacterial enteropathogens from stool cultures in clinical laboratories is one of the primary means by which public health officials identify and track outbreaks of bacterial gastroenteritis. This article provides guidance for clinical microbiology laboratories that perform stool cultures. The general characteristics, epidemiology, and clinical manifestations of key bacterial enteropathogens are summarized. Information regarding optimal specimen collection, transport, and processing and current diagnostic tests and testing algorithms is provided. This article is an update of Cumitech 12A (P. H. Gilligan, J. M. Janda, M. A. Karmali, and J. M. Miller, Cumitech 12A, Laboratory diagnosis of bacterial diarrhea, 1992).

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“…Spore formation is essential for C. difficile to survive exit from the host and transmit disease because its vegetative cells are exquisitely sensitive to oxygen (8). Furthermore, C. difficile spores are resistant to antibiotics (9), attacks from the host's immune system (10), and disinfectants commonly used in hospital settings due to their metabolic dormancy and intrinsic resistance properties (11)(12)(13)(14). Thus, understanding the mechanisms controlling C. difficile spore germination may have practical applications in the management of C. difficile infections as this knowledge may lead to new methods for preventing spore germination or efficiently promoting it to facilitate killing of the less resistant germinated spores.…”

Section: Importancementioning

confidence: 99%

Characterization of the Dynamic Germination of Individual Clostridium difficile Spores Using Raman Spectroscopy and Differential Interference Contrast Microscopy

et al. 2015

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The Gram-positive spore-forming anaerobe Clostridium difficile is a leading cause of nosocomial diarrhea. Spores of C. difficile initiate infection when triggered to germinate by bile salts in the gastrointestinal tract. We analyzed germination kinetics of individual C. difficile spores using Raman spectroscopy and differential interference contrast (DIC) microscopy. Similar to Bacillus spores, individual C. difficile spores germinating with taurocholate plus glycine began slow leakage of a ϳ15% concentration of a chelate of Ca 2؉ and dipicolinic acid (CaDPA) at a heterogeneous time T 1 , rapidly released CaDPA at T lag , completed CaDPA release at T release , and finished peptidoglycan cortex hydrolysis at T lysis . T 1 and T lag values for individual spores were heterogeneous, but ⌬T release periods (T release ؊ T lag ) were relatively constant. In contrast to Bacillus spores, heat treatment did not stimulate spore germination in the two C. difficile strains tested. C. difficile spores did not germinate with taurocholate or glycine alone, and different bile salts differentially promoted spore germination, with taurocholate and taurodeoxycholate being best. Transient exposure of spores to taurocholate plus glycine was sufficient to commit individual spores to germinate. C. difficile spores did not germinate with CaDPA, in contrast to B. subtilis and C. perfringens spores. However, the detergent dodecylamine induced C. difficile spore germination, and rates were increased by spore coat removal although cortex hydrolysis did not follow T release , in contrast with B. subtilis. C. difficile spores lacking the cortex-lytic enzyme, SleC, germinated extremely poorly, and cortex hydrolysis was not observed in the few sleC spores that partially germinated. Overall, these findings indicate that C. difficile and B. subtilis spore germination exhibit key differences. IMPORTANCESpores of the Gram-positive anaerobe Clostridium difficile are responsible for initiating infection by this important nosocomial pathogen. When exposed to germinants such as bile salts, C. difficile spores return to life through germination in the gastrointestinal tract and cause disease, but their germination has been studied only with population-wide measurements. In this work we used Raman spectroscopy and DIC microscopy to monitor the kinetics of germination of individual C. difficile spores, the commitment of spores to germination, and the effect of germinant type and concentration, sublethal heat shock, and spore decoating on germination. Our data suggest that the order of germination events in C. difficile spores differs from that in Bacillus spores and provide new insights into C. difficile spore germination. C lostridium difficile is a Gram-positive, spore-forming, strictly anaerobic bacterium that has become a leading cause of antibiotic-associated diarrhea worldwide (1). Antibiotic treatment disrupts the normal colonic flora that typically suppresses C. difficile growth and allows ingested C. difficile spores to germinate, outgrow...

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Spread and persistence of Clostridium difficile spores during and after cleaning with sporicidal disinfectants

Cited by 33 publications

References 7 publications

A Novel Quantitative Sampling Technique for Detection and Monitoring of Clostridium difficile Contamination in the Clinical Environment

A Novel Quantitative Sampling Technique for Detection and Monitoring of Clostridium difficile Contamination in the Clinical Environment

Practical Guidance for Clinical Microbiology Laboratories: Diagnosis of Bacterial Gastroenteritis

Characterization of the Dynamic Germination of Individual Clostridium difficile Spores Using Raman Spectroscopy and Differential Interference Contrast Microscopy

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