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Epidemic strains of C. difficile found in playground sandboxes
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Sandboxes in playgrounds that are unprotected from dogs and wild animals may harbor Clostridium difficile and expose children to epidemic strains of the bacteria, according to a study published in Zoonoses and Public Health.
José L. Blanco, PhD, DVM, from the department of animal health at the Complutense University of Madrid, and colleagues studied the presence of C. difficile in 20 pairs of sandboxes for children and dogs located in different playgrounds within the region of Madrid, Spain.
C. difficile was present in 21 of 40 samples taken (52.5%). Of the 20 available isolates, eight were classified as toxigenic ribotypes — 014 (n = 5) and 106 (n = 2), both of which are considered epidemic, and CD047 (n = 1). Other isolates detected in the sandboxes were classified as nontoxigenic, including ribotypes 009 (n = 5), 039 (n = 4), 067 (n = 1), 151 (n = 1) and CD048 (n = 1).
“The growing number of pets and other animals leaving excrement in the sandboxes of playgrounds and other recreational areas constitutes a serious epidemiological threat,” Blanco and colleagues wrote. “Current tests for assessing the sanitary conditions of sandboxes focus on detecting some select pathogenic parasites and bacterial indicators of fecal contamination, but mostly neglect the possible presence of other emerging pathogens such as C. difficile.” – by Katherine Bortz
- Reference:
- Orden C, et al. Zoonoses Public Health. 2017. doi:10.1111/zph.12374.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Andi L. Shane MD MPH MSc, Associate professor of pediatrics
Clostridium difficile is ubiquitous in the environment. In addition to the detections noted in human and animal sandboxes in Spain in this study, toxigenic and nontoxigenic strains have been detected in public space lawns in Western Australia and soil in Chile. These surveillance studies underscore the need for exposure prevention.
Andi L. Shane
Hand hygiene following exposure to soil and sand and avoiding eating and drinking while playing in soil and sand are two main ways that children can reduce their exposure to soil and sand pathogens. Covering open sand boxes to reduce opportunities for animal contact with human play spaces is another strategy that may reduce opportunities for exposure to animal pathogens. Antimicrobial stewardship to reduce the opportunities for the emergence of organisms including Clostridium difficile will also reduce opportunities for colonization and transmission of antimicrobial-resistant organisms.
Although 45% of the human and 60% of the canine sandbox samples were notable for the detection of C. difficile, only two of the human and canine sandbox samples were notable for the detection of C. difficile organisms with identical ribotypes; this implies that transmission from human to canine sandboxes and back is likely not occurring, based on this point prevalence sampling study.
However, meticulous hand hygiene and the discouragement of hand-to-mouth contact after sandbox exposure is beneficial to prevent the potential transmission of any organism that may be present in a sandbox. In addition, owners of domestic animals should remove any organic matter from pets in sandboxes and communal recreation areas to avoid opportunities for exposure and transmission of organisms to other animals and humans.
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