Abstract
Clostridioides difficile is responsible for most cases of antibiotic- and hospital-associated diarrhoea. Several studies have demonstrated the presence of C. difficile in different foods such as meat, raw milk, vegetables and seafood, which supports the hypothesis that foods contaminated with spores may be contributing to the exposure to and transmission of C. difficile. Generally, the prevalence of C. difficile in foods is low and there is no standard methodology for its isolation. Available methods have been optimized for stool samples rather than foods. In the majority of the studies, a similar base culture medium has been used and different selective and enrichment compounds are further added, which is, sometimes, controversial. Despite the extensive use of cycloserine and cefoxitin, as well as moxalactam and norfloxacin, many authors believe that the use of these selective supplements had an adverse effect on the recovery of C. difficile and only enabled recovery of resistant isolates from food samples. Another example is the use of sodium taurocholate to potentiate the germination of C. difficile spores; there are studies reporting that the addition of this component in the enrichment medium did not exert a beneficial effect on C. difficile recovery. Variations in sample amounts, dilution factors, incubation times, among others, may also affect the recovery of C. difficile from foods. Numerous studies have recently emerged, since there is increasing interest in C. difficile as a potentially foodborne pathogen. Thus, the purpose of this review is to summarize the methodologies currently used on the isolation/detection of C. difficile in foods and its subsequent characterization and typing.
Highlights
Clostridioides difficile [1] is a spore-forming human pathogen that is the main cause of antibiotic- and hospital-associated diarrhoea [2]
To understand what type of enrichment medium was the most effective for the recovery of C. difficile from chopped beef inoculated with 100 colony forming units/g C. difficile, Chai et al [72] used two non-selective media: Brain heart infusion with 0.1% sodium taurocholate (TBHI) and cooked meat medium with 0.1% sodium taurocholate (TCM); and two selective media: selective media with cycloserine and cefoxitin (TCCFB) and selective media with cysteine hydrochloride (TCMN)
The purpose of this study was to present an overview of the methodologies that have been used to recover C. difficile from food samples; despite several studies having been reported, there is no widely accepted methodology for the detection/enumeration of this bacterium in foods
Summary
Clostridioides difficile (formerly Clostridium difficile) [1] is a spore-forming human pathogen that is the main cause of antibiotic- and hospital-associated diarrhoea [2]. Many studies have demonstrated their presence in four food categories: i) meat, such in ground beef [6], pork meat [7], chicken meat [8,9] and poultry meat [10]; ii) dairy products, e.g. raw milk [11]; iii) vegetables, e.g. raw vegetables [12], leafy greens [13], processed vegetables [14] and lettuce [15,16,17], and iv) seafood, e.g. molluscs [18], shellfish [11,19] and seafood [20] Contamination of these foods by C. difficile spores may be due to the fact that they are susceptible to faecal contamination. Clostridioides difficile species comprises several ribotypes [2] and the most commonly identified as a cause of disease in humans have been found in foods such as retail meat (ribotypes 027 and 078) [26,27,28], raw milk (ribotype 078) [11] and ready-to-eat salads (ribotypes 001, 078 and 126) [9,11,12]
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