Abstract
The increased prevalence of Clostridium difficile infection (CDI) has coincided with enhanced transmissibility and severity of disease, which is often linked to two distinct clonal lineages designated PCR-ribotype 027 and 017 responsible for CDI outbreaks in the USA, Europe and Asia. We assessed sporulation and susceptibility of three PCR-ribotypes; 012, 017 and 027 to four classes of disinfectants; chlorine releasing agents (CRAs), peroxygens, quaternary ammonium compounds (QAC) and biguanides. The 017 PCR-ribotype, showed the highest sporulation frequency under these test conditions. The oxidizing biocides and CRAs were the most efficacious in decontamination of C. difficile vegetative cells and spores, the efficacy of the CRAs were concentration dependent irrespective of PCR-ribotype. However, there were differences observed in the susceptibility of the PCR-ribotypes, independent of the concentrations tested for Virkon®, Newgenn®, Proceine 40® and Hibiscrub®. Whereas, for Steri7® and Biocleanse® the difference observed between the disinfectants were dependent on both PCR-ribotype and concentration. The oxidizing agent Perasafe® was consistently efficacious across all three PCR ribotypes at varying concentrations; with a consistent five Log10 reduction in spore titre. The PCR-ribotype and concentration dependent differences in the efficacy of the disinfectants in this study indicate that disinfectant choice is a factor for llimiting the survival and transmission of C. difficile spores in healthcare settings.
Highlights
Clostridium difficile-infection (CDI) is an antibiotic associated diarrhoea, caused by C. difficile, a Gram-positive, spore-forming anaerobic bacillus
Sporulation of C. difficile PCR-ribotypes Spore production is a unique feature of C. difficile among other important healthcare pathogens, vegetative cell production and sporulation of three representative PCRribotypes 012, 017 and 027 (Figure 1a) was analysed
The spores produced by C. difficile enhance transmission due to their ability to survive in the environment [18,29,30] and resists biocides [19,20,21]
Summary
Clostridium difficile-infection (CDI) is an antibiotic associated diarrhoea, caused by C. difficile, a Gram-positive, spore-forming anaerobic bacillus. Antibiotic therapy is proposed to elicit CDI by disruption of the intestinal microbiota, which enables colonization of the gastrointestinal tract by indigenous or ingested C. difficile. C. difficile was first recognized as a pathogen over 30 years ago, and primarily CDI was associated with immune suppressed and elderly patients, receiving antibiotic treatment [1]. In the last 10 years C. difficile has emerged as a global pathogen, with epidemics across Europe, Asia and the USA, culminating in the transcontinental spread of ‘hypervirulent’ PCR-ribotypes [2,3,4]. C. difficile is the most frequent cause of nosocomial diarrhoea worldwide [10,11]. C. difficile has a unique advantage over other healthcare associated communicable infections such as methicillin resistant
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