Abstract
Clostridium difficile is a spore-forming, toxin-producing human and animal pathogen. In humans, disease is primarily hospital-associated; antibiotic exposure and advanced age are major risk factors. However, the epidemiology of C. difficile has changed recently with the emergence of an antibiotic-resistant lineage and community-associated cases among individuals without traditional risk factors. The finding of C. difficile in food animals and retail foods has raised concerns that C. difficile may be a foodborne pathogen. However, the role of food as a cause of human C. difficile infection (CDI) has been difficult to assess. Transient asymptomatic carriage among healthy human subjects has been reported but the source of C. difficile colonization is unclear. Prospective studies investigating associations of diet, asymptomatic carriage, and human CDI are required to understand the complex epidemiology of C. difficile. On-farm antibiotic management and molecular epidemiologic surveillance will be necessary to mitigate emergence, spread, and potential zoonotic transmission of this important pathogen.
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