Abstract
Clostridium difficile is a well-established hospital pathogen. Recently, it has been detected increasingly in patients without hospital contact. Given this rise in community associated infections with C. difficile, we hypothesized that the environment could play an important role in transmission of spores outside the hospital. Lawn samples (311) collected in public spaces in the metropolitan area of Perth, Western Australia, from February to June 2016 were cultured for C. difficile. C. difficile was isolated from the samples by direct and enrichment culture, and characterized by standard molecular methods using toxin gene PCR and ribotyping. The overall prevalence of C. difficile was 59%, new lawn (≤4 months old) was twice as likely as old lawn (>4 months old) to test positive (OR = 2.3; 95%CI 1.16–4.57, p = 0.015) and 35 C. difficile ribotypes were identified with toxigenic ribotype 014/020 (39%) predominating. The highest viable count from lawn soil samples was 1200 CFU/g. These results show that lawns in Perth, Western Australia, harbor toxigenic C. difficile, an important finding. The source of lawn contamination is likely related to modern practice of producing “roll-out” lawn. Further work should focus on identifying specific management practices that lead to C. difficile contamination of lawn to inform prevention and control measures.
Highlights
Clostridium difficile is a well-established hospital pathogen associated with outbreaks of severe gastroenteritis[1]
In the unadjusted univariable model, C. difficile was more likely to be detected in newly established (NL) than OL (OR = 2.11, 95% CI: 1.32–3.4, p = 0.001) compared to the adjusted model (OR = 2.30, 95% (CI: 1.16–4.57, p = 0.015) (Table 1)
Age of lawn was the only variable that was significantly associated with detection of C. difficile (OR = 1.92, 95% (CI: 1.15–3.21, p = 0.013)
Summary
Clostridium difficile is a well-established hospital pathogen associated with outbreaks of severe gastroenteritis[1]. There has been an increase in the incidence of community-associated CDI (CA-CDI) both in Australia[4] and elsewhere[5] Because of this increase in CA-CDI4–6, food sources have emerged as a potential reservoir of C. difficile. Foodborne transmission of CDI is plausible it has never been proven, and the environment may be another important source of CA-CDI13,14 This is evident from many studies where various ribotypes (RTs) of C. difficile have been detected from the environment including so-called hypervirulent strains (RT 001, 014, 027, 045, 066, 078, and 126)[15,16,17]. The mesophilic treatment of biosolids does not reduce C. difficile spore load[25,26] and, application of biosolids to landscaping including private and public space lawns could transmit C. difficile in the community. We investigated factors such as the location and size of the lawn to see if they could predict C. difficile status
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