C. difficile prevalent in non-health care settings — especially on shoes
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Global surveillance of Clostridioides difficile showed that it was widely prevalent among isolates collected outside of health care settings — especially on the soles of shoes, according to researchers at IDWeek.
“Our lab specializes in C. difficile, with a particular emphasis on environmental microbiology,” Jinhee Jo, PharmD, a post-doctoral infectious disease fellow at the University of Houston, told Healio. “We had previously demonstrated high C. difficile contamination in parks and homes around Houston, Texas, and wanted to expand this effort globally.”
Jo and colleagues collected environmental swabs from public areas, health care settings and shoe soles between 2014 and 2017 in the United States and internationally and tested them to assess the prevalence and strains of C. difficile.
They collected a total of 11,986 isolates, primarily from the U.S. (n = 11,002), but also from 11 other countries, including Taiwan (n = 200) and India (n = 187). They categorized the samples as being from outdoor environments (n = 2,992), private residences (n = 2,772), shoe soles (n = 1,420), public buildings (n = 1,104) or acute-care settings (n = 3,698).
Overall, 26% of samples were positive for C. difficile, according to Jo and colleagues, and sample positivity was similar between the U.S. and non-U.S. sampling sites.
In the U.S., private residences (26.2%) and outdoor environments (24.1%) had the highest positivity rate compared with public buildings (17.2%). In Texas (n = 8,571), positivity rates were highest from outdoor samples (27%) and were similar between private residences (24%) and health care buildings (24%).
Shoe soles had the highest positivity rate (45%) with similar ribotype (RT) distribution between shoe soles and environmental samples.
Among all samples, the researchers found that the most prevalent RTs overall were F014-020 (16.4%), F106 (14.9%), and FP310 (11%).
“Our research showed that although C. difficile has been historically recognized as a health care-associated infection, C. difficile spores are also highly prevalent in the global community — non-health care settings such as public buildings and outdoor spaces,” Jo said. “This suggested a potential role for surveillance efforts and infection control measures in the community to reduce community-acquired C. difficile infection cases.”
In a press release, Kevin W. Garey, PharmD, MS, FASHP, a professor of pharmacy practice at the University of Houston College of Pharmacy, said the results “shift our understanding of C. difficile,” including where it is found, how it is transmitted and who it affects.
“We can no longer think of C. difficile as only existing in health care settings, and the population at risk is no longer just the very sick patient in the hospital,” said Garey, who one of the researchers on the study. “Identifying that person at risk anywhere in the world should become a priority, regardless of whether the person is in a hospital or the community.”
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