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Epidemic strains of C. difficile detected within playground sandboxes
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Sandboxes in playgrounds that are unprotected from dogs and other wild animals may harbor epidemic strains of Clostridium difficile, posing a significant health risk to children, according to a study published in Zoonoses and Public Health.
“The soil of playgrounds is a reservoir of diverse parasites and infectious agents. Free access of domestic and wild animals to recreational areas can increase the burden of microbiological contamination,” José L. Blanco, PhD, DVM, from the department of animal health at the Complutense University of Madrid, and colleagues wrote. “Children are generally regarded as the main group at risk for environmental exposure to pathogens, not only because they are frequent users of playgrounds, but also due to the high prevalence of geophagia within this group, and the immaturity of their immunological, neurological and digestive systems.”
To determine the presence of C. difficile in sandboxes to which dogs and other animals may have been exposed, the researchers conducted an isolation process through enrichment and selective culture procedures. The diversity of ribotype and amplified fragment length polymorphism (AFLP) was determined for the bacteria found within sandboxes in playgrounds located in 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], 106 [n = 2] and CD047 (n = 1)]. Ribotypes 014 and 106 were considered epidemic in these samples. Other isolates detected in sandboxes were detected as nontoxigenic and included ribotypes 009 (n=5), 039 (n=4), 067,151 and CD048 (one each).
“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
Disclosure: The researcher provides no relevant financial disclosures.
Perspective
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Andi L. Shane, MD, MPH, MSc
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 non-toxigenic strains have been detected from public space lawns in Western Australia and soil in Chile. These surveillance studies underscore the need for exposure prevention.
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 difficilewill 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 2 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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