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Soni A, Parlane NA, Khan F, Derraik JGB, Wild CEK, Anderson YC, Brightwell G. Efficacy of Dry Heat Treatment against Clostridioides difficile Spores and Mycobacterium tuberculosis on Filtering Facepiece Respirators. Pathogens 2022; 11:pathogens11080871. [PMID: 36014991 PMCID: PMC9415841 DOI: 10.3390/pathogens11080871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 02/04/2023] Open
Abstract
The COVID-19 pandemic has required novel solutions, including heat disinfection of personal protective equipment (PPE) for potential reuse to ensure availability for healthcare and other frontline workers. Understanding the efficacy of such methods on pathogens other than SARS-CoV-2 that may be present on PPE in healthcare settings is key to worker safety, as some pathogenic bacteria are more heat resistant than SARS-CoV-2. We assessed the efficacy of dry heat treatment against Clostridioides difficile spores and Mycobacterium tuberculosis (M. tb) on filtering facepiece respirator (FFR) coupons in two inoculums. Soil load (mimicking respiratory secretions) and deionized water was used for C. difficile, whereas, soil load and PBS and Tween mixture was used for M. tb. Dry heat treatment at 85 °C for 240 min resulted in a reduction equivalent to 6.0-log10 CFU and 7.3-log10 CFU in C. difficile spores inoculated in soil load and deionized water, respectively. Conversely, treatment at 75 °C for 240 min led to 4.6-log10 CFU reductions in both soil load and deionized water. C. difficile inactivation was higher by >1.5-log10 CFU in deionized water as compared to soil load (p < 0.0001), indicating the latter has a protective effect on bacterial spore inactivation at 85 °C. For M. tb, heat treatment at 75 °C for 90 min and 85 °C for 30 min led to 8-log10 reduction with or without soil load. Heat treatment near the estimated maximal operating temperatures of FFR materials (which would readily eliminate SARS-CoV-2) did not achieve complete inactivation of C. difficile spores but was successful against M. tb. The clinical relevance of surviving C. difficile spores when subjected to heat treatment remains unclear. Given this, any disinfection method of PPE for potential reuse must ensure the discarding of any PPE, potentially contaminated with C. difficile spores, to ensure the safety of healthcare workers.
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Affiliation(s)
- Aswathi Soni
- Food System Integrity, Hopkirk Research Institute, AgResearch, Palmerston North 4442, New Zealand;
| | - Natalie A. Parlane
- Animal Health Solutions, Grasslands Research Centre, Hopkirk Research Institute, AgResearch, Private Bag 11008, Palmerston North 4442, New Zealand; (N.A.P.); (F.K.)
| | - Farina Khan
- Animal Health Solutions, Grasslands Research Centre, Hopkirk Research Institute, AgResearch, Private Bag 11008, Palmerston North 4442, New Zealand; (N.A.P.); (F.K.)
| | - José G. B. Derraik
- Department of Pediatrics: Child and Youth Health, University of Auckland, Private Bag 92109, Auckland 1142, New Zealand; (J.G.B.D.); (C.E.K.W.)
| | - Cervantée E. K. Wild
- Department of Pediatrics: Child and Youth Health, University of Auckland, Private Bag 92109, Auckland 1142, New Zealand; (J.G.B.D.); (C.E.K.W.)
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Yvonne C. Anderson
- Department of Pediatrics: Child and Youth Health, University of Auckland, Private Bag 92109, Auckland 1142, New Zealand; (J.G.B.D.); (C.E.K.W.)
- enAble Institute, Faculty of Health Sciences, Curtin University, Bentley, WA 6102, Australia
- Telethon Kids Institute, Northern Entrance, Perth Children’s Hospital, Nedlands, WA 6009, Australia
- Community Health, Child and Adolescent Health Service, Perth, WA 6009, Australia
- Correspondence: (Y.C.A.); (G.B.)
| | - Gale Brightwell
- Food System Integrity, Hopkirk Research Institute, AgResearch, Palmerston North 4442, New Zealand;
- New Zealand Food Safety Science Research Centre, Palmerston North 4474, New Zealand
- Correspondence: (Y.C.A.); (G.B.)
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2
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Finsterwalder SK, Loncaric I, Cabal A, Szostak MP, Barf LM, Marz M, Allerberger F, Burgener IA, Tichy A, Feßler AT, Schwarz S, Monecke S, Ehricht R, Ruppitsch W, Spergser J, Künzel F. Dogs as carriers of virulent and resistant genotypes of Clostridioides difficile. Zoonoses Public Health 2022; 69:673-681. [PMID: 35546073 PMCID: PMC9544694 DOI: 10.1111/zph.12956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/19/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022]
Abstract
While previous research on zoonotic transmission of community-acquired Clostridioides difficile infection (CA-CDI) focused on food-producing animals, the present study aimed to investigate whether dogs are carriers of resistant and/or virulent C. difficile strains. Rectal swabs were collected from 323 dogs and 38 C. difficile isolates (11.8%) were obtained. Isolates were characterized by antimicrobial susceptibility testing, whole-genome sequencing (WGS) and a DNA hybridization assay. Multilocus sequence typing (MLST), core genome MLST (cgMLST) and screening for virulence and antimicrobial resistance genes were performed based on WGS. Minimum inhibitory concentrations for erythromycin, clindamycin, tetracycline, vancomycin and metronidazole were determined by E-test. Out of 38 C. difficile isolates, 28 (73.7%) carried genes for toxins. The majority of isolates belonged to MLST sequence types (STs) of clade I and one to clade V. Several isolates belonged to STs previously associated with human CA-CDI. However, cgMLST showed low genetic relatedness between the isolates of this study and C. difficile strains isolated from humans in Austria for which genome sequences were publicly available. Four isolates (10.5%) displayed resistance to three of the tested antimicrobial agents. Isolates exhibited resistance to erythromycin, clindamycin, tetracycline and metronidazole. These phenotypic resistances were supported by the presence of the resistance genes erm(B), cfr(C) and tet(M). All isolates were susceptible to vancomycin. Our results indicate that dogs may carry virulent and antimicrobial-resistant C. difficile strains.
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Affiliation(s)
- S K Finsterwalder
- Institute of Microbiology, University of Veterinary Medicine Vienna, Vienna, Austria.,Clinical Unit of Internal Medicine Small Animals, University of Veterinary Medicine Vienna, Vienna, Austria
| | - I Loncaric
- Institute of Microbiology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - A Cabal
- AGES - Austrian Agency for Health and Food Safety, Vienna, Austria
| | - M P Szostak
- Institute of Microbiology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - L M Barf
- Faculty of Mathematics and Computer Science, Friedrich Schiller University Jena, Jena, Germany.,Max Planck Institute for Science of Human History, Jena, Germany
| | - M Marz
- Faculty of Mathematics and Computer Science, Friedrich Schiller University Jena, Jena, Germany.,FLI Leibniz Institute for Age Research, Jena, Germany.,InfectoGnostics Research Campus Jena, Jena, Germany
| | - F Allerberger
- AGES - Austrian Agency for Health and Food Safety, Vienna, Austria
| | - I A Burgener
- Clinical Unit of Internal Medicine Small Animals, University of Veterinary Medicine Vienna, Vienna, Austria
| | - A Tichy
- Department of Biomedical Science, University of Veterinary Medicine Vienna, Vienna, Austria
| | - A T Feßler
- Department of Veterinary Medicine, Centre of Infection Medicine, Institute of Microbiology and Epizootics, Freie Universität Berlin, Berlin, Germany.,Department of Veterinary Medicine, Veterinary Centre for Resistance Research (TZR), Freie Universität Berlin, Berlin, Germany
| | - S Schwarz
- Department of Veterinary Medicine, Centre of Infection Medicine, Institute of Microbiology and Epizootics, Freie Universität Berlin, Berlin, Germany.,Department of Veterinary Medicine, Veterinary Centre for Resistance Research (TZR), Freie Universität Berlin, Berlin, Germany
| | - S Monecke
- InfectoGnostics Research Campus Jena, Jena, Germany.,Leibniz Institute of Photonic Technology (IPHT), Jena, Germany.,Institut für Medizinische Mikrobiologie und Hygiene, Universitätsklinik Dresden, Dresden, Germany
| | - R Ehricht
- InfectoGnostics Research Campus Jena, Jena, Germany.,Leibniz Institute of Photonic Technology (IPHT), Jena, Germany.,Institute of Physical Chemistry, Friedrich Schiller University Jena, Jena, Germany
| | - W Ruppitsch
- AGES - Austrian Agency for Health and Food Safety, Vienna, Austria
| | - J Spergser
- Institute of Microbiology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - F Künzel
- Clinical Unit of Internal Medicine Small Animals, University of Veterinary Medicine Vienna, Vienna, Austria
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3
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Ahn SW, Lee SH, Kim UJ, Jang HC, Choi HJ, Choy HE, Kang SJ, Roh SW. Genomic characterization of nine Clostridioides difficile strains isolated from Korean patients with Clostridioides difficile infection. Gut Pathog 2021; 13:55. [PMID: 34530913 PMCID: PMC8447795 DOI: 10.1186/s13099-021-00451-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/08/2021] [Indexed: 12/14/2022] Open
Abstract
Background Clostridioides difficile infection (CDI) is an infectious nosocomial disease caused by Clostridioides difficile, an opportunistic pathogen that occurs in the intestine after extensive antibiotic regimens. Results Nine C. difficile strains (CBA7201–CBA7209) were isolated from nine patients diagnosed with CDI at the national university hospital in Korea, and the whole genomes of these strains were sequenced to identify their genomic characteristics. Comparative genomic analysis was performed using 51 reference strains and the nine isolated herein. Phylogenetic analysis based on 16S rRNA gene sequences confirmed that all 60 C. difficile strains belong to the genus Clostridioides, while core-genome tree indicated that they were divided into five groups, which was consistent with the results of MLST clade analysis. All strains were confirmed to have a clindamycin antibiotic resistance gene, but the other antibiotic resistance genes differ depending on the MLST clade. Interestingly, the six strains belonging to the sequence type 17 among the nine C. difficile strains isolated here exhibited unique genomic characteristics for PaLoc and CdtLoc, the two toxin gene loci identified in this study, and harbored similar antibiotic resistance genes. Conclusion In this study, we identified the specific genomic characteristics of Korean C. difficile strains, which could serve as basic information for CDI prevention and treatment in Korea. Supplementary Information The online version contains supplementary material available at 10.1186/s13099-021-00451-3.
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Affiliation(s)
- Seung Woo Ahn
- Microbiology and Functionality Research Group, World Institute of Kimchi, 86, Kimchi-ro, Nam-gu, 61755, Gwangju, Republic of Korea
| | - Se Hee Lee
- Microbiology and Functionality Research Group, World Institute of Kimchi, 86, Kimchi-ro, Nam-gu, 61755, Gwangju, Republic of Korea
| | - Uh Jin Kim
- Department of Infectious Diseases, Chonnam National University Hospital, 61469, Gwangju, Republic of Korea
| | - Hee-Chang Jang
- Department of Infectious Diseases, Chonnam National University Hospital, 61469, Gwangju, Republic of Korea
| | - Hak-Jong Choi
- Microbiology and Functionality Research Group, World Institute of Kimchi, 86, Kimchi-ro, Nam-gu, 61755, Gwangju, Republic of Korea
| | - Hyon E Choy
- Department of Microbiology, Chonnam National University Medical School, 61469, Gwangju, Republic of Korea
| | - Seung Ji Kang
- Department of Infectious Diseases, Chonnam National University Hospital, 61469, Gwangju, Republic of Korea.
| | - Seong Woon Roh
- Microbiology and Functionality Research Group, World Institute of Kimchi, 86, Kimchi-ro, Nam-gu, 61755, Gwangju, Republic of Korea.
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Nho SW, Kim M, Kim SJ, Foley SL, Nayak R, Kweon O, Cerniglia CE. Pragmatic Strategy for Fecal Specimen Storage and the Corresponding Test Methods for Clostridioides difficile Diagnosis. Pathogens 2021; 10:pathogens10081049. [PMID: 34451512 PMCID: PMC8400358 DOI: 10.3390/pathogens10081049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 12/02/2022] Open
Abstract
The quality of fecal specimens is one of the factors responsible for successful Clostridioides difficile infection (CDI) diagnosis. The quality depends largely on the storage conditions, including the temperature and time period. In this study, we organized the outputs of previous studies, filled experimental gaps in the knowledge of storage conditions, and introduced a pragmatic strategy for fecal storage for CDI diagnosis. A 5-step pathway was adopted to develop the fecal specimen storage strategy as follows: step 1, bibliomic analysis; step 2, experimental gap-filling; step 3, comparative evaluation; step 4, strategy development; step 5, internal review. Step 1 identified eight articles providing experimental information on the effects of fecal specimen storage conditions on the effectiveness of C. difficile detection methods. Step 2 provided additional quantitative data on C. difficile vegetative and spore cell viability and DNA stability. All previous and current results were compared (step 3). In step 4, fir general and nine special strategies were developed, followed by an internal review of the overall approaches (step 5). It is recommended to separate fecal samples into aliquots before testing and storing them. It is particularly recommended that fecal specimen samples be stored for CDI diagnosis at 4 °C for up to 60 days for all test methods.
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Affiliation(s)
- Seong Won Nho
- Division of Microbiology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079, USA; (S.W.N.); (M.K.); (S.-J.K.); (S.L.F.)
| | - Minjae Kim
- Division of Microbiology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079, USA; (S.W.N.); (M.K.); (S.-J.K.); (S.L.F.)
| | - Seong-Jae Kim
- Division of Microbiology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079, USA; (S.W.N.); (M.K.); (S.-J.K.); (S.L.F.)
| | - Steven L. Foley
- Division of Microbiology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079, USA; (S.W.N.); (M.K.); (S.-J.K.); (S.L.F.)
| | - Rajesh Nayak
- Office of Regulatory Compliance and Risk Management, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079, USA;
| | - Ohgew Kweon
- Division of Microbiology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079, USA; (S.W.N.); (M.K.); (S.-J.K.); (S.L.F.)
- Correspondence: (O.K.); (C.E.C.)
| | - Carl E. Cerniglia
- Division of Microbiology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079, USA; (S.W.N.); (M.K.); (S.-J.K.); (S.L.F.)
- Correspondence: (O.K.); (C.E.C.)
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Cocchi M, Danesi P, De Zan G, Leati M, Gagliazzo L, Ruggeri M, Palei M, Bremini A, Rossmann MC, Lippert-Petscharnig M, Mansfeld MD, Deotto S, Leardini S, Gobbo F, Zucca P, De Benedictis P. A Three-Year Biocrime Sanitary Surveillance on Illegally Imported Companion Animals. Pathogens 2021; 10:1047. [PMID: 34451511 PMCID: PMC8399716 DOI: 10.3390/pathogens10081047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 12/04/2022] Open
Abstract
The illegal trade of companion animals in the European Union poses several legal, ethical and health issues to the entire community. In the framework of the Biocrime Interreg project between Italy and Austria, we surveyed puppies and kittens confiscated at the borders to identify the most frequent pathogens associated with (i) the risk of spread within the shelter, (ii) the development of fatal disease and (iii) the zoonotic potential. From January 2018 to December 2020, we examined a total of 613 puppies and 62 kittens coming from 44 requisitions. Feces, skin specimens and blood sera from confiscated animals were tested to verify the presence of major infections and to assess the rabies post-vaccination immunity. Out of the total of individuals under investigation, necropsies and laboratory investigations were also performed on 79 puppies and three kittens that had died during the observation period. Results indicated a high prevalence of Canine Parvovirus (CPV) and Giardia spp. infections, CPV as the most likely cause of fatal gastroenteritis in puppies and Salmonella and Microsporum canis as major zoonotic pathogens. Conversely, both extended spectrum beta lactamases Escherichia coli and methicillin resistant Staphylococcus pseudintermedius strains as rare findings. Results highlighted that illegal animal trade could expose the human population to potential zoonotic risk and naïve animal population to potentially disrupting epidemic waves, both of these issues being largely underestimated when buying companion animals.
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Affiliation(s)
- Monia Cocchi
- Istituto Zooprofilattico Sperimentale Delle Venezie, Sezione territoriale di Udine, 33030 Basaldella di Campoformido, Italy; (M.C.); (G.D.Z.); (S.D.)
| | - Patrizia Danesi
- National Reference Centre/OIE Collaborating Centre for Diseases at the Animal-Human Interface, Istituto Zooprofilattico Sperimentale Delle Venezie, 35020 Legnaro, Italy; (P.D.); (S.L.); (F.G.)
- Laboratory of Parasitology, Istituto Zooprofilattico Sperimentale Delle Venezie, 35020 Legnaro, Italy
| | - Gabrita De Zan
- Istituto Zooprofilattico Sperimentale Delle Venezie, Sezione territoriale di Udine, 33030 Basaldella di Campoformido, Italy; (M.C.); (G.D.Z.); (S.D.)
| | - Marta Leati
- National Reference Laboratory for Salmonella, Istituto Zooprofilattico Sperimentale Delle Venezie, Laboratory of Parasitology, 35020 Legnaro, Italy;
| | - Laura Gagliazzo
- Istituto Zooprofilattico Sperimentale Delle Venezie, Epidemiology and Biostatistics, 35020 Legnaro, Italy; (L.G.); (M.R.)
| | - Margherita Ruggeri
- Istituto Zooprofilattico Sperimentale Delle Venezie, Epidemiology and Biostatistics, 35020 Legnaro, Italy; (L.G.); (M.R.)
| | - Manlio Palei
- Central Directorate for Health, Social Policies and Disabilities, Friuli Venezia Giulia Region, 34123 Trieste, Italy; (M.P.); (A.B.); (P.Z.)
| | - Alessandro Bremini
- Central Directorate for Health, Social Policies and Disabilities, Friuli Venezia Giulia Region, 34123 Trieste, Italy; (M.P.); (A.B.); (P.Z.)
- Biocrime Veterinary Medical Intelligence Centre, c/o International Police and Custom Cooperation Centre, Thörl-Maglern, 9602 Arnoldstein, Austria;
| | - Marie-Christin Rossmann
- Biocrime Veterinary Medical Intelligence Centre, c/o International Police and Custom Cooperation Centre, Thörl-Maglern, 9602 Arnoldstein, Austria;
- Agiculture, Forestry, Rural Areas Veterinary Department, Land Carinthia, 9020 Klagenfurt, Austria
| | - Melanie Lippert-Petscharnig
- Amt der Kärntner Landesregierung, Institut für Lebensmittelsicherheit, Veterinärmedizin und Umwelt (ILV Kärnten), Laborbereichsleitung Serologie/PCR/Fischdiagnostik, 9020 Klagenfurt, Austria;
| | - Michael-Dieter Mansfeld
- Amt der Kärntner Landesregierung, Institut für Lebensmittelsicherheit, Veterinärmedizin und Umwelt (ILV Kärnten), Laborbereichsleitung Bakteriologie/Hämatologie, 9020 Klagenfurt, Austria;
| | - Silvia Deotto
- Istituto Zooprofilattico Sperimentale Delle Venezie, Sezione territoriale di Udine, 33030 Basaldella di Campoformido, Italy; (M.C.); (G.D.Z.); (S.D.)
| | - Sofia Leardini
- National Reference Centre/OIE Collaborating Centre for Diseases at the Animal-Human Interface, Istituto Zooprofilattico Sperimentale Delle Venezie, 35020 Legnaro, Italy; (P.D.); (S.L.); (F.G.)
- Istituto Zooprofilattico Sperimentale Delle Venezie, Laboratory of Special Virology, 35020 Legnaro, Italy
| | - Federica Gobbo
- National Reference Centre/OIE Collaborating Centre for Diseases at the Animal-Human Interface, Istituto Zooprofilattico Sperimentale Delle Venezie, 35020 Legnaro, Italy; (P.D.); (S.L.); (F.G.)
- Istituto Zooprofilattico Sperimentale Delle Venezie, Laboratory of Special Virology, 35020 Legnaro, Italy
| | - Paolo Zucca
- Central Directorate for Health, Social Policies and Disabilities, Friuli Venezia Giulia Region, 34123 Trieste, Italy; (M.P.); (A.B.); (P.Z.)
- Biocrime Veterinary Medical Intelligence Centre, c/o International Police and Custom Cooperation Centre, Thörl-Maglern, 9602 Arnoldstein, Austria;
| | - Paola De Benedictis
- National Reference Centre/OIE Collaborating Centre for Diseases at the Animal-Human Interface, Istituto Zooprofilattico Sperimentale Delle Venezie, 35020 Legnaro, Italy; (P.D.); (S.L.); (F.G.)
- National and FAO Reference Centre for Rabies, Istituto Zooprofilattico Sperimentale Delle Venezie, 35020 Legnaro, Italy
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Anis E, Barnart D, Barnard A, Kelly DJ, Redding LE. Performance of commercial PCR assays to detect toxigenic Clostridioides difficile in the feces of puppies. Vet Med Sci 2021; 7:1536-1541. [PMID: 34216115 PMCID: PMC8464299 DOI: 10.1002/vms3.567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Clostridioides difficile is an important enteric pathogen that causes significant morbidity and mortality in humans. With community‐acquired infections on the rise, it is important to identify reservoirs of the pathogen. Companion animals can be asymptomatic carriers of C. difficile and may therefore represent a reservoir, but epidemiological studies of C. difficile within the pet‐owner unit are needed, along with validated methods to detect C. difficile in both people and animals. The goal of this study was to assess the performance of commercial qPCR assays and a multiplex PCR for C. difficile compared to toxigenic culture. These assays were tested on up to 103 fecal samples from puppies, a population in which the prevalence of C. difficile is the highest. The sensitivities, specificities, positive predictive values and negative predictive values were respectively 84.2%, 87.7%, 61.5%, and 95.9% for the Cepheid GeneXpert; 66.7%, 66.7%, 29.6%, and 90.9% for the DiaSorin Simplexa; and 94.4%, 85.0%, 65.4%, and 98.1%, for the multiplex qPCR. The agreement was highest between the GeneXpert and the multiplex PCR (90.1% agreement, with a kappa statistic of 0.77). For diagnostic purposes, the positive predictive values of the assays were low. However, the high sensitivities of the assays could render them useful for epidemiologic purposes. Companion animals might be a reservoir of Clostridioides difficile. Diagnostic assays that are validated in both people and pets are needed to conduct epidemiological investigations within the pet‐owner unit. We found that at least one commercial PCR assay to detect C. difficile in people is also highly sensitive in dogs and could therefore be used for epidemiological purposes within the pet‐owner unit.
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Affiliation(s)
- Eman Anis
- School of Veterinary Medicine, University of Pennsylvania, Kennett Square, Pennsylvania, USA
| | - Denise Barnart
- School of Veterinary Medicine, University of Pennsylvania, Kennett Square, Pennsylvania, USA
| | - Amanda Barnard
- School of Veterinary Medicine, University of Pennsylvania, Kennett Square, Pennsylvania, USA
| | - Donna J Kelly
- School of Veterinary Medicine, University of Pennsylvania, Kennett Square, Pennsylvania, USA
| | - Laurel E Redding
- School of Veterinary Medicine, University of Pennsylvania, Kennett Square, Pennsylvania, USA
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7
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Clostridioides difficile in Calves in Central Italy: Prevalence, Molecular Typing, Antimicrobial Susceptibility and Association with Antibiotic Administration. Animals (Basel) 2021; 11:ani11020515. [PMID: 33669325 PMCID: PMC7920295 DOI: 10.3390/ani11020515] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/09/2021] [Accepted: 02/12/2021] [Indexed: 12/28/2022] Open
Abstract
Simple Summary Clostridioides difficile is a leading cause of nosocomial and community-acquired diarrhoea in men. The infection most commonly occurs in people who have recently been treated with antibiotics. Indistinguishable C. difficile strains have been isolated from livestock and humans, which has shed light on a possible zoonotic origin of this infection. This study aimed to assess the prevalence and risk factors of C. difficile in calves bred in dairy and beef cattle farms of the Umbria, central Italy. We estimated a 19.8% prevalence of farms positive for C. difficile. The C. difficile isolates from calves were potentially toxigenic and resistant to antibiotics, including lincosamides, quinolones, vancomycin and linezolid. Isolates belonging to ribotype RT-126, which is also commonly reported in humans, showed the highest number of resistance to the antimicrobials tested. Furthermore, we observed an almost sixfold increased risk for C. difficile on farms where penicillins had been prescribed. This, together with the detection of toxigenic and antibiotic-resistant isolates, strongly suggests the need for a reduction of antibiotic use in cattle. Abstract The emergence of Clostridioides difficile as the main agent of antibiotic-associated diarrhoea has raised concerns about its potential zoonotic role in different animal species. The use of antimicrobials is a major risk factor for C. difficile infection. Here, we provide data on C. difficile infection in dairy and beef calves in Umbria, a region in central Italy. This cross-sectional study focuses on prevalence, risk factors, ribotypes, toxinotypes and antimicrobial resistance profiles of circulating ribotypes. A prevalence of 19.8% (CI95%, 12–27.6%) positive farms was estimated, and the prescription of penicillins on the farms was associated with C. difficile detection (OR = 5.58). Eleven different ribotypes were found, including the ST11 sublineages RT-126 and -078, which are also commonly reported in humans. Thirteen isolates out of 17 showed resistance to at least one of clindamycin, moxifloxacin, linezolid and vancomycin. Among them, multiple-drug resistance was observed in two isolates, belonging to RT-126. Furthermore, RT-126 isolates were positive for tetracycline resistance determinants, confirming that tetracycline resistance is widespread among ST11 isolates from cattle. The administration of penicillins increased the risk of C. difficile in calves: this, together with the recovery of multi-resistant strains, strongly suggests the need for minimising antibiotic misuse on cattle farms.
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8
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Candel-Pérez C, Santaella-Pascual J, Ros-Berruezo G, Martínez-Graciá C. Occurrence of Clostridioides (Clostridium) difficile in Poultry Giblets at Slaughter and in Retail Pork and Poultry Meat in Southeastern Spain. J Food Prot 2021; 84:310-314. [PMID: 33513258 DOI: 10.4315/jfp-20-256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/27/2020] [Accepted: 09/30/2020] [Indexed: 01/27/2023]
Abstract
ABSTRACT Raw meat and meat products contaminated with Clostridioides difficile could be a vehicle for spreading community-associated C. difficile infection. This study was conducted to determine the occurrence of C. difficile in pork and poultry meat samples (n = 325) from retail establishments and in edible giblet samples (n = 36) from a poultry processing plant in Murcia (southeastern Spain). C. difficile was isolated after selective enrichment from 2% (6 of 361) of the samples, all of which were from the poultry processing plant. These isolates were recovered from 17% (6 of 36) of the edible chicken giblets, i.e., 28% (5 of 18) of the gizzard samples and 6% (1 of 18) of the liver samples. All six C. difficile isolates were negative for toxin A and B genes by PCR assay. These findings indicate that C. difficile can survive in the gastric acid of the chicken gizzard and could be transmitted to other meat products. However, the very low prevalence of C. difficile in the tested samples indicates that retail meat may not be an important source for transmission of C. difficile to humans. HIGHLIGHTS
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Affiliation(s)
- Carmen Candel-Pérez
- Department of Food Science and Nutrition, Veterinary Faculty, Regional Campus of International Excellence Campus Mare Nostrum, University of Murcia, Murcia 30100, Spain.,(ORCID: https://orcid.org/0000-0002-1088-1695 [C.C.P.])
| | - Javier Santaella-Pascual
- Department of Food Science and Nutrition, Veterinary Faculty, Regional Campus of International Excellence Campus Mare Nostrum, University of Murcia, Murcia 30100, Spain
| | - Gaspar Ros-Berruezo
- Department of Food Science and Nutrition, Veterinary Faculty, Regional Campus of International Excellence Campus Mare Nostrum, University of Murcia, Murcia 30100, Spain
| | - Carmen Martínez-Graciá
- Department of Food Science and Nutrition, Veterinary Faculty, Regional Campus of International Excellence Campus Mare Nostrum, University of Murcia, Murcia 30100, Spain
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9
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Berry ASF, Kelly BJ, Barnhart D, Kelly DJ, Beiting DP, Baldassano RN, Redding LE. Gut microbiota features associated with Clostridioides difficile colonization in puppies. PLoS One 2019; 14:e0215497. [PMID: 31469837 PMCID: PMC6716646 DOI: 10.1371/journal.pone.0215497] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 08/05/2019] [Indexed: 02/06/2023] Open
Abstract
In people, colonization with Clostridioides difficile, the leading cause of antibiotic-associated diarrhea, has been shown to be associated with distinct gut microbial features, including reduced bacterial community diversity and depletion of key taxa. In dogs, the gut microbiota features that define C. difficile colonization are less well understood. We sought to define the gut microbiota features associated with C. difficile colonization in puppies, a population where the prevalence of C. difficile has been shown to be elevated, and to define the effect of puppy age and litter upon these features and C. difficile risk. We collected fecal samples from weaned (n = 27) and unweaned (n = 74) puppies from 13 litters and analyzed the effects of colonization status, age and litter on microbial diversity using linear mixed effects models. Colonization with C. difficile was significantly associated with younger age, and colonized puppies had significantly decreased bacterial community diversity and differentially abundant taxa compared to non-colonized puppies, even when adjusting for age. C. difficile colonization remained associated with decreased bacterial community diversity, but the association did not reach statistical significance in a mixed effects model incorporating litter as a random effect. Even though litter explained a greater proportion (67%) of the variability in microbial diversity than colonization status, we nevertheless observed heterogeneity in gut microbial community diversity and colonization status within more than half of the litters, suggesting that the gut microbiota contributes to colonization resistance against C. difficile. The colonization of puppies with C. difficile has important implications for the potential zoonotic transfer of this organism to people. The identified associations point to mechanisms by which C. difficile colonization may be reduced.
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Affiliation(s)
- Alexander S. F. Berry
- Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Brendan J. Kelly
- Divisions of Infectious Diseases and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Denise Barnhart
- Department of Pathobiology, University of Pennsylvania, School of Veterinary Medicine, Kennett Square, Pennsylvania, United States of America
| | - Donna J. Kelly
- Department of Pathobiology, University of Pennsylvania, School of Veterinary Medicine, Kennett Square, Pennsylvania, United States of America
| | - Daniel P. Beiting
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Robert N. Baldassano
- Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Laurel E. Redding
- Department of Clinical Sciences, University of Pennsylvania, School of Veterinary Medicine, Kennett Square, Pennsylvania, United States of America
- * E-mail:
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10
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Candel-Pérez C, Martínez-Miró S, Ros-Berruezo G, Martínez-Graciá C. Effect of Specimen Type and Processing on the Detection of Clostridioides [Clostridium] difficile in Piglet Fecal Samples. Foodborne Pathog Dis 2019; 16:731-737. [PMID: 31225737 DOI: 10.1089/fpd.2019.2629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Subclinical Clostridioides difficile colonization in piglets could be a potential source of this bacterium for community-acquired C. difficile infection. The purposes of this study were to assess the effect of specimen type and processing on C. difficile isolation, culture, and detection by polymerase chain reaction (PCR), and to determine the occurrence of C. difficile in piglets of different ages. We compared different culture procedures-direct plating, ethanol shock, and an enrichment step-to isolate C. difficile from swine feces and rectal swabs. DNA was isolated directly from feces, processed feces, and bacterial isolates to detect the triose phosphate isomerase (tpi) gene and identify the toxins A and B genes. The results show that ethanol shock increased the C. difficile isolation from feces, while it decreased it for rectal swabs, in comparison with direct plating. The use of the enrichment broth gave the highest C. difficile recovery from both types of specimen. Our findings show low sensitivity for tpi gene detection after the DNA extraction directly from feces and an increase in PCR-positive samples when feces were processed before the DNA extraction. The overall prevalence of C. difficile was 16.9% (22/130), of which 100% were found to be toxigenic as assessed by the enrichment culture of fecal samples. The rate of isolation of positive samples decreased with the animal age, regardless of the presence or absence of diarrhea. Our results demonstrate the persistent reservoir of toxigenic C. difficile in fecal samples of piglets and support the impact of specimen processing on its isolation.
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Affiliation(s)
- Carmen Candel-Pérez
- Department of Food Science and Nutrition, Veterinary Faculty, Regional Campus of International Excellence Campus Mare Nostrum, University of Murcia, Murcia, Spain
| | - Silvia Martínez-Miró
- Department of Animal Production, Veterinary Faculty, Regional Campus of International Excellence Campus Mare Nostrum, University of Murcia, Murcia, Spain
| | - Gaspar Ros-Berruezo
- Department of Food Science and Nutrition, Veterinary Faculty, Regional Campus of International Excellence Campus Mare Nostrum, University of Murcia, Murcia, Spain
| | - Carmen Martínez-Graciá
- Department of Food Science and Nutrition, Veterinary Faculty, Regional Campus of International Excellence Campus Mare Nostrum, University of Murcia, Murcia, Spain
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11
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Halstead F, Ravi A, Thomson N, Nuur M, Hughes K, Brailey M, Oppenheim B. Whole genome sequencing of toxigenic Clostridium difficile in asymptomatic carriers: insights into possible role in transmission. J Hosp Infect 2019; 102:125-134. [DOI: 10.1016/j.jhin.2018.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 10/15/2018] [Indexed: 01/05/2023]
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12
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Dharmasena M, Wei T, Bridges WC, Jiang X. Thermal resistance of Clostridium difficile endospores in dairy compost upon exposure to wet and dry heat treatments. J Appl Microbiol 2019; 127:274-283. [PMID: 31034124 DOI: 10.1111/jam.14295] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 04/04/2019] [Accepted: 04/22/2019] [Indexed: 11/28/2022]
Abstract
AIM Thermal resistance of Clostridium difficile endospores in finished dairy compost was compared at 55 and 65°C under wet and dry heat conditions. METHODS AND RESULTS A three-strain cocktail of C. difficile endospores was inoculated into dairy compost to a final concentration of c. 5·5 log CFU per gram and the moisture content (MC) of the compost was adjusted to be 20, 30 and 40%. For the dry heat treatment at 55 and 65°C, the compost samples were placed in an environmental chamber, whereas for the wet heat treatment, the inoculated compost samples were placed in a tray submerged in a water bath. The MCs of composts were maintained well throughout the wet heat treatment while the dry heat treatment reduced the MCs of composts to <10% by the end of come-up time. During the come-up time, the log endospore reductions at a selected temperature were not significantly different in compost with three selected MCs, in each heat treatment. During the holding time, endospore counts reduced by <0·5 log CFU per gram at 55 and 65°C of dry heat treatment, whereas 0·7-0·8 and 0·6-3·0 log CFU per gram reductions were observed at 55 and 65°C in wet heat treatment respectively. CONCLUSION The recommended minimum composting guidelines were not sufficient to reduce C. difficile endospore counts to an undetectable level (five endospores per gram). Increasing the temperature of thermophilic phase to 65°C, and maintaining higher MCs of composting feedstocks have significant (P < 0·05) effects on the endospore inactivation. SIGNIFICANCE AND IMPACT OF THE STUDY Our study identified factors that significantly affecting the thermal resistance of C. difficile endospores during composting, and the results suggest the current composting guidelines need to be amended in order to reduce the dissemination of C. difficile endospores in agricultural environment.
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Affiliation(s)
- M Dharmasena
- Department of Food, Nutrition, and Packaging Sciences, Clemson University, Clemson, SC, USA
| | - T Wei
- Department of Mathematical Sciences, Clemson University, Clemson, SC, USA
| | - W C Bridges
- Department of Mathematical Sciences, Clemson University, Clemson, SC, USA
| | - X Jiang
- Department of Food, Nutrition, and Packaging Sciences, Clemson University, Clemson, SC, USA
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13
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Candel-Pérez C, Ros-Berruezo G, Martínez-Graciá C. A review of Clostridioides [Clostridium] difficile occurrence through the food chain. Food Microbiol 2019; 77:118-129. [DOI: 10.1016/j.fm.2018.08.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/01/2018] [Accepted: 08/21/2018] [Indexed: 12/18/2022]
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14
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Development of an optimized broth enrichment culture medium for the isolation of Clostridium difficile. Anaerobe 2018; 54:92-99. [DOI: 10.1016/j.anaerobe.2018.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/26/2018] [Accepted: 08/13/2018] [Indexed: 02/04/2023]
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15
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Biasizzo M, Vadnjal S, Henigman U, Krizman M, Kirbis A, Jamnikar-Ciglenecki U. Development and Validation of a New Protocol for Detecting and Recovering Clostridium difficile from Meat Samples. J Food Prot 2018; 81:561-568. [PMID: 29517350 DOI: 10.4315/0362-028x.jfp-17-354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
There is no recommended protocol for detecting and isolating Clostridium difficile present in food samples. Here, we have evaluated the recovery of C. difficile in meat samples after incubating them in various enrichment broths. The media were as follows: cycloserine-cefoxitin fructose broth supplemented with taurocholic acid, d-cycloserine, cefoxitin, and lysozyme; cycloserine-cefoxitin mannitol broth with taurocholate and lysozyme; and cycloserine-cefoxitin fructose broth supplemented with taurocholic acid, C. difficile moxalactam norfloxacin selective supplement, and lysozyme. Samples were inoculated with various strains and quantities of C. difficile and then enriched in the different broths for 1, 4, and 7 days. C. difficile was isolated on agar plates and detected with quantitative real-time PCR (qPCR). The procedure using enrichment in cycloserine-cefoxitin fructose broth supplemented with taurocholic acid, d-cycloserine, cefoxitin, and lysozyme and incubation for 4 days for qPCR detection and 7 days for isolation (plating on C. difficile agar base with added C. difficile selective supplement and 7% [v/v] defibrinated horse blood after alcoholic shock and centrifugation) was validated. Samples of different kinds of meat and meat preparation were contaminated and used for validation of the chosen protocol. The sensitivity of detection with qPCR was 100%, and the sensitivity of the isolation method was 96%.
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Affiliation(s)
- Majda Biasizzo
- Institute of Food Safety, Feed and Environment, Veterinary Faculty, University of Ljubljana, Gerbičeva 60, 1000 Ljubljana, Slovenia
| | - Stanka Vadnjal
- Institute of Food Safety, Feed and Environment, Veterinary Faculty, University of Ljubljana, Gerbičeva 60, 1000 Ljubljana, Slovenia
| | - Urska Henigman
- Institute of Food Safety, Feed and Environment, Veterinary Faculty, University of Ljubljana, Gerbičeva 60, 1000 Ljubljana, Slovenia
| | - Manja Krizman
- Institute of Food Safety, Feed and Environment, Veterinary Faculty, University of Ljubljana, Gerbičeva 60, 1000 Ljubljana, Slovenia
| | - Andrej Kirbis
- Institute of Food Safety, Feed and Environment, Veterinary Faculty, University of Ljubljana, Gerbičeva 60, 1000 Ljubljana, Slovenia
| | - Urska Jamnikar-Ciglenecki
- Institute of Food Safety, Feed and Environment, Veterinary Faculty, University of Ljubljana, Gerbičeva 60, 1000 Ljubljana, Slovenia
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16
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Abstract
This study was to optimize the detection methods for Clostridium difficile from the animal manure-based composts. Both autoclaved and unautoclaved dairy composts were inoculated with a 12-h old suspension of a non-toxigenic C. difficile strain (ATCC 43593) and then plated on selected agar for vegetative cells and endospores. Six types of enrichment broths supplemented with taurocholate and l-cysteine were assessed for detecting a low level of artificially inoculated C. difficile (ca. 5 spores/g) from dairy composts. The efficacy of selected enrichment broths was further evaluated by isolating C. difficile from 29 commercial compost samples. Our results revealed that using heat-shock was more effective than using ethanol-shock for inducing endospore germination, and the highest endospore count (p < 0.05) was yielded at 60 °C for 25 min. C. difficile agar base, supplemented with 0.1% l-cysteine, 7% defibrinated horse blood, and cycloserine-cefoxitin (CDA-CYS-H-CC agar) was the best medium (p < 0.05) for recovering vegetative cells from compost. C. difficile endospore populations from both types of composts enumerated on both CDA-CYS-H-CC agar supplemented with 0.1% sodium taurocholate (CDA-CYS-H-CC-T agar) and brain heart infusion agar supplemented with 0.5% yeast extract, 0.1% l-cysteine, cycloserine-cefoxitin, and 0.1% sodium taurocholate (BHIA-YE-CYS-CC-T agar) media were not significantly different from each other (p > 0.05). Overall, enrichment of inoculated compost samples in broths containing moxalactam-norfloxacin (MN) produced significantly higher (p < 0.05) spore counts than in non-selective broths or broths supplemented with CC. Enrichment in BHIB-YE-CYS-MN-T broth followed by culturing on an agar containing 7% horse blood and 0.1% taurocholate provided a more sensitive and selective combination of media for detecting a low population of C. difficile from environmental samples with high background microflora.
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Affiliation(s)
- Muthu Dharmasena
- Department of Food, Nutrition, and Packaging Sciences, Clemson University, Clemson, SC 29634, USA
| | - Xiuping Jiang
- Department of Food, Nutrition, and Packaging Sciences, Clemson University, Clemson, SC 29634, USA.
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17
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PCR-ribotype distribution of Clostridium difficile in Irish pigs. Anaerobe 2017; 48:237-241. [DOI: 10.1016/j.anaerobe.2017.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 09/25/2017] [Accepted: 10/07/2017] [Indexed: 01/05/2023]
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18
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Liu M, Yin Q, Brennan JD, Li Y. Selection and characterization of DNA aptamers for detection of glutamate dehydrogenase from Clostridium difficile. Biochimie 2017; 145:151-157. [PMID: 28882627 DOI: 10.1016/j.biochi.2017.08.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 08/31/2017] [Indexed: 12/18/2022]
Abstract
Rapid and accurate diagnosis of Clostridium difficile infections (CDI) is crucial for patient treatment, infection control and epidemiological monitoring. As an important antigen, glutamate dehydrogenase (GDH) has been proposed as a preliminary screening test target for CDI. However, current assays based on GDH activity or GDH immunoassays have suboptimal sensitivity and specificity. Herein, we describe the selection and characterization of single-stranded DNA aptamers that specifically target GDH. After 10 rounds of selection, high-throughput sequencing was used to identify enriched aptamer candidates. Of 10 candidates, three aptamers for GDH were identified. Gel shift assays showed that these aptamers exhibited low nanomolar affinities. One aptamer was optimized based on structural analysis and further engineered into a structure-switching fluorescence signaling aptamer, wherein desorption from reduced graphene oxide (RGO) upon binding of GDH led to an increase in fluorescence emission. This method allowed for quantitative detection of GDH with a detection limit of 1 nM, providing great potential for its further application in CDI diagnosis.
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Affiliation(s)
- Meng Liu
- Department of Biochemistry and Biomedical Sciences, and Department of Chemistry and Chemical Biology, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada; Biointerfaces Institute, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 0A3, Canada; School of Environmental Science and Technology, Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education), Dalian University of Technology, Dalian, 116024, China
| | - Qingxin Yin
- School of Environmental Science and Technology, Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education), Dalian University of Technology, Dalian, 116024, China
| | - John D Brennan
- Department of Biochemistry and Biomedical Sciences, and Department of Chemistry and Chemical Biology, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada; Biointerfaces Institute, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 0A3, Canada; The Michael G. DeGroote Institute for Infectious Disease Research (IIDR), McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Yingfu Li
- Department of Biochemistry and Biomedical Sciences, and Department of Chemistry and Chemical Biology, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada; Biointerfaces Institute, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 0A3, Canada; The Michael G. DeGroote Institute for Infectious Disease Research (IIDR), McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
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19
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Stoltz KL, Erickson R, Staley C, Weingarden AR, Romens E, Steer CJ, Khoruts A, Sadowsky MJ, Dosa PI. Synthesis and Biological Evaluation of Bile Acid Analogues Inhibitory to Clostridium difficile Spore Germination. J Med Chem 2017; 60:3451-3471. [PMID: 28402634 DOI: 10.1021/acs.jmedchem.7b00295] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Standard antibiotic-based strategies for the treatment of Clostridium difficile infections disrupt indigenous microbiota and commonly fail to eradicate bacterial spores, two key factors that allow recurrence of infection. As an alternative approach to controlling C. difficile infection, a series of bile acid derivatives have been prepared that inhibit taurocholate-induced spore germination. These analogues have been evaluated in a highly virulent NAP1 strain using optical density and phase-contrast microscopy assays. Heterocycle substitutions at C24 were well-tolerated and several tetrazole-containing derivatives were highly potent inhibitors in both assays, with complete inhibition of spore germination observed at 10-25 μM. To limit intestinal absorption, C7-sulfated analogues designed to avoid active and passive transport pathways were prepared. One of these derivatives, compound 21b, was found to be a potent inhibitor of C. difficile spore germination and poorly permeable in a Caco-2 model of intestinal epithelial absorption, suggesting that it is likely to be gut-restricted.
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Affiliation(s)
- Kristen L Stoltz
- Institute for Therapeutics Discovery and Development, Department of Medicinal Chemistry, University of Minnesota , 717 Delaware Street SE, Minneapolis, Minnesota 55414, United States
| | - Raymond Erickson
- BioTechnology Institute, University of Minnesota , 1479 Gortner Avenue, St. Paul, Minnesota 55108, United States
| | - Christopher Staley
- BioTechnology Institute, University of Minnesota , 1479 Gortner Avenue, St. Paul, Minnesota 55108, United States
| | - Alexa R Weingarden
- BioTechnology Institute, University of Minnesota , 1479 Gortner Avenue, St. Paul, Minnesota 55108, United States.,Department of Microbiology and Immunology, University of Minnesota , St. Paul, Minnesota 55108, United States
| | - Erin Romens
- BioTechnology Institute, University of Minnesota , 1479 Gortner Avenue, St. Paul, Minnesota 55108, United States
| | - Clifford J Steer
- Departments of Medicine and Genetics, Cell Biology, and Development, University of Minnesota , VFW Cancer Research Center, 406 Harvard Street, Minneapolis, Minnesota, United States
| | - Alexander Khoruts
- BioTechnology Institute, University of Minnesota , 1479 Gortner Avenue, St. Paul, Minnesota 55108, United States.,Department of Medicine, Division of Gastroenterology, University of Minnesota , Minneapolis, Minnesota 55414, United States.,Center for Immunology, University of Minnesota , Minneapolis, Minnesota 55414, United States
| | - Michael J Sadowsky
- BioTechnology Institute, University of Minnesota , 1479 Gortner Avenue, St. Paul, Minnesota 55108, United States.,Department of Soil, Water & Climate, University of Minnesota , St. Paul, Minnesota 55108, United States
| | - Peter I Dosa
- Institute for Therapeutics Discovery and Development, Department of Medicinal Chemistry, University of Minnesota , 717 Delaware Street SE, Minneapolis, Minnesota 55414, United States
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20
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Abstract
Clostridium difficile infections (CDIs) have emerged as one of the principal threats to the health of hospitalized and immunocompromised patients. The importance of C difficile colonization is increasingly recognized not only as a source for false-positive clinical testing but also as a source of new infections within hospitals and other health care environments. In the last five years, several new treatment strategies that capitalize on the increasing understanding of the altered microbiome and host defenses in patients with CDI have completed clinical trials, including fecal microbiota transplantation. This article highlights the changing epidemiology, laboratory diagnostics, pathogenesis, and treatment of CDI.
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21
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Reigadas E, Alcalá L, Marín M, Martín A, Bouza E. C. difficile PCR-ribotype 023 might go undetected when using ChromId C. difficile agar. Anaerobe 2017; 44:34-35. [PMID: 28108388 DOI: 10.1016/j.anaerobe.2017.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 01/10/2017] [Accepted: 01/14/2017] [Indexed: 01/05/2023]
Abstract
We compared the performance of the new chromogenic medium ChromID C. difficile with that of CLO agar. ChromID C. difficile agar is a sensitive medium that can accelerate the presumptive identification of C. difficile, however ribotype 023 might go undetected when using this chromogenic medium.
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Affiliation(s)
- E Reigadas
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - L Alcalá
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
| | - M Marín
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
| | - A Martín
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - E Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain.
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22
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Arroyo L, Costa M, Guest B, Plattner B, Lillie B, Weese J. Duodenitis-Proximal Jejunitis in Horses After Experimental Administration of Clostridium difficile Toxins. J Vet Intern Med 2017; 31:158-163. [PMID: 27906466 PMCID: PMC5259639 DOI: 10.1111/jvim.14624] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 09/13/2016] [Accepted: 11/03/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Duodenitis-proximal jejunitis (DPJ) is an acute sporadic gastrointestinal disorder of horses of unknown cause. HYPOTHESIS/OBJECTIVES We hypothesize that Clostridium difficile toxins are involved in the pathogenesis of DPJ in horses. The objective of this study was to determine whether experimentally delivered C. difficile toxins cause clinical signs and histologic lesions similar to those of naturally occurring DPJ. ANIMALS Six healthy mature mixed breed horses. METHODS Experimental study: animal model of animal disease. Fasted horses were administered crude C. difficile toxins via gastroscopy and monitored for up to 48 hour. Blood was collected for complete blood cell count, biochemistry profile, and plasma fibrinogen assay, and abdominal fluid was collected for cytologic analysis and total solids before and after toxin administration. Physical examination and abdominal ultrasonography were performed throughout the study period. Tissues were collected from the gastrointestinal tract and processed for routine histologic analysis, and lesions were scored. RESULTS Clinical signs were observed in 2 of 6 horses that are typical although not specific for horses with naturally occurring DPJ. Histopathologic lesions were observed in 6 of 6 horses and were similar to those reported in horses with naturally occurring DPJ. Two horses were severely affected. CONCLUSIONS AND CLINICAL IMPORTANCE Duodenitis-proximal jejunitis is likely a syndrome with multiple causes that result in the same clinical and pathologic findings, and our data suggest that the toxins of C. difficile represent one cause of this syndrome. Toxin dose and variation in individual animal susceptibility might affect the clinical signs and lesions after administration of C. difficile toxins.
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Affiliation(s)
- L.G. Arroyo
- Department of Clinical StudiesOntario Veterinary CollegeUniversity of GuelphGuelphONCanada
| | - M.C. Costa
- Department of Clinical StudiesOntario Veterinary CollegeUniversity of GuelphGuelphONCanada
| | - B.B. Guest
- Department of Clinical StudiesOntario Veterinary CollegeUniversity of GuelphGuelphONCanada
| | - B.L. Plattner
- Department of PathobiologyOntario Veterinary CollegeUniversity of GuelphGuelphONCanada
| | - B.N. Lillie
- Department of PathobiologyOntario Veterinary CollegeUniversity of GuelphGuelphONCanada
| | - J.S. Weese
- Department of PathobiologyOntario Veterinary CollegeUniversity of GuelphGuelphONCanada
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23
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Ursodeoxycholic Acid Inhibits Clostridium difficile Spore Germination and Vegetative Growth, and Prevents the Recurrence of Ileal Pouchitis Associated With the Infection. J Clin Gastroenterol 2016; 50:624-30. [PMID: 26485102 PMCID: PMC4834285 DOI: 10.1097/mcg.0000000000000427] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
GOALS To test whether ursodeoxycholic acid (UDCA) is inhibitory to Clostridium difficile and can be used in the treatment of C. difficile-associated ileal pouchitis. BACKGROUND The restoration of secondary bile metabolism may be the key mechanism for fecal microbiota transplantation (FMT) in treating recurrent C. difficile infections (RCDI). Therefore, it is possible that exogenous administration of inhibitory bile acids may be used directly as nonantibiotic therapeutics for this indication. The need for such a treatment alternative is especially significant in patients with refractory C. difficile-associated pouchitis, where the efficacy of FMT may be limited. STUDY We measured the ability of UDCA to suppress the germination and the vegetative growth of 11 clinical isolate strains of C. difficile from patients treated with FMT for RCDI. In addition, we used oral UDCA to treat a patient with RCDI pouchitis that proved refractory to multiple antibiotic treatments and FMT. RESULTS UDCA was found to be inhibitory to the germination and the vegetative growth of all C. difficile strains tested. Fecal concentrations of UDCA from the patient with RCDI pouchitis exceeded levels necessary to inhibit the germination and the growth of C. difficile in vitro. The patient has remained infection free for over 10 months after the initiation of UDCA. CONCLUSIONS UDCA can be considered as a therapeutic option in patients with C. difficile-associated pouchitis. Further studies need to be conducted to define the optimal dose and duration of such a treatment. In addition, bile acid derivatives inhibitory to C. difficile that are able to achieve high intracolonic concentrations may be developed as therapeutics for RCDI colitis.
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Environmental Contamination in Households of Patients with Recurrent Clostridium difficile Infection. Appl Environ Microbiol 2016; 82:2686-2692. [PMID: 26921425 DOI: 10.1128/aem.03888-15] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 02/18/2016] [Indexed: 12/18/2022] Open
Abstract
Recurrent Clostridium difficile infection (R-CDI) is common and difficult to treat, potentially necessitating fecal microbiota transplantation (FMT). Although C. difficilespores persist in the hospital environment and cause infection, little is known about their potential presence or importance in the household environment. Households of R-CDI subjects in the peri-FMT period and of geographically matched and age-matched controls were analyzed for the presence ofC. difficile Household environmental surfaces and fecal samples from humans and pets in the household were examined. Households of post-FMT subjects were also examined (environmental surfaces only). Participants were surveyed regarding their personal history and household cleaning habits. Species identity and molecular characteristics of presumptive C. difficile isolates from environmental and fecal samples were determined by using the Pro kit (Remel, USA), Gram staining, PCR, toxinotyping, tcdC gene sequencing, and pulsed-field gel electrophoresis (PFGE). Environmental cultures detected C. difficile on ≥1 surface in 8/8 (100%) peri-FMT households, versus 3/8 (38%) post-FMT households and 3/8 (38%) control households (P= 0.025). The most common C. difficile-positive sites were the vacuum (11/27; 41%), toilet (8/30; 27%), and bathroom sink (5/29; 17%).C. difficile was detected in 3/36 (8%) fecal samples (two R-CDI subjects and one household member). Nine (90%) of 10 households with multiple C. difficile-positive samples had a single genotype present each. In conclusion,C. difficile was found in the household environment of R-CDI patients, but whether it was found as a cause or consequence of R-CDI is unknown. If household contamination leads to R-CDI, effective decontamination may be protective.
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Weingarden AR, Dosa PI, DeWinter E, Steer CJ, Shaughnessy MK, Johnson JR, Khoruts A, Sadowsky MJ. Changes in Colonic Bile Acid Composition following Fecal Microbiota Transplantation Are Sufficient to Control Clostridium difficile Germination and Growth. PLoS One 2016; 11:e0147210. [PMID: 26789728 PMCID: PMC4720481 DOI: 10.1371/journal.pone.0147210] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/30/2015] [Indexed: 12/22/2022] Open
Abstract
Fecal microbiota transplantation (FMT) is a highly effective therapy for recurrent Clostridium difficile infection (R-CDI), but its mechanisms remain poorly understood. Emerging evidence suggests that gut bile acids have significant influence on the physiology of C. difficile, and therefore on patient susceptibility to recurrent infection. We analyzed spore germination of 10 clinical C. difficile isolates exposed to combinations of bile acids present in patient feces before and after FMT. Bile acids at concentrations found in patients' feces prior to FMT induced germination of C. difficile, although with variable potency across different strains. However, bile acids at concentrations found in patients after FMT did not induce germination and inhibited vegetative growth of all C. difficile strains. Sequencing of the newly identified germinant receptor in C. difficile, CspC, revealed a possible correspondence of variation in germination responses across isolates with mutations in this receptor. This may be related to interstrain variability in spore germination and vegetative growth in response to bile acids seen in this and other studies. These results support the idea that intra-colonic bile acids play a key mechanistic role in the success of FMT, and suggests that novel therapeutic alternatives for treatment of R-CDI may be developed by targeted manipulation of bile acid composition in the colon.
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Affiliation(s)
- Alexa R. Weingarden
- Department of Microbiology and Immunology, University of Minnesota, St. Paul, Minnesota, United States of America
- The BioTechnology Institute, University of Minnesota, St. Paul, Minnesota, United States of America
| | - Peter I. Dosa
- Department of Medicinal Chemistry—Institute for Therapeutics Discovery and Development, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Erin DeWinter
- The BioTechnology Institute, University of Minnesota, St. Paul, Minnesota, United States of America
| | - Clifford J. Steer
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Megan K. Shaughnessy
- Department of Medicine, Division of Infectious Diseases, University of Minnesota, Minneapolis, Minnesota, United States of America
- Minneapolis Veterans Affairs (VA) Healthcare System, Division of Infectious Diseases, Minneapolis, Minnesota, United States of America
| | - James R. Johnson
- Department of Medicine, Division of Infectious Diseases, University of Minnesota, Minneapolis, Minnesota, United States of America
- Minneapolis Veterans Affairs (VA) Healthcare System, Division of Infectious Diseases, Minneapolis, Minnesota, United States of America
| | - Alexander Khoruts
- The BioTechnology Institute, University of Minnesota, St. Paul, Minnesota, United States of America
- Department of Medicine, Division of Gastroenterology, University of Minnesota, Minneapolis, Minnesota, United States of America
- Center for Immunology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Michael J. Sadowsky
- The BioTechnology Institute, University of Minnesota, St. Paul, Minnesota, United States of America
- Department of Soil, Water & Climate, University of Minnesota, St. Paul, Minnesota, United States of America
- * E-mail:
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Becker SL, Chatigre JK, Coulibaly JT, Mertens P, Bonfoh B, Herrmann M, Kuijper EJ, N'Goran EK, Utzinger J, von Müller L. Molecular and culture-based diagnosis of Clostridium difficile isolates from Côte d'Ivoire after prolonged storage at disrupted cold chain conditions. Trans R Soc Trop Med Hyg 2015; 109:660-8. [PMID: 26354793 DOI: 10.1093/trstmh/trv071] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/12/2015] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Although Clostridium difficile is a major cause of diarrhoea, its epidemiology in tropical settings is poorly understood. Strain characterisation requires work-up in specialised laboratories, often after prolonged storage without properly maintained cold chain. METHODS We screened 298 human faecal samples from Côte d'Ivoire using a rapid test for C. difficile glutamate dehydrogenase (GDH). GDH-positive samples were aerobically stored at disrupted cold chain conditions (mean duration: 11 days) before transfer to a reference laboratory for anaerobic culture, susceptibility testing, PCR assays and ribotyping. RESULTS Sixteen samples (5.4%) had a positive GDH screening test. C. difficile infection was confirmed in six specimens by culture and PCR, while no nucleic acids of C. difficile were detected in the culture-negative samples. Further analysis of stool samples harbouring toxigenic C. difficile strains confirmed that both GDH and toxins remained detectable for at least 28 days, regardless of storage conditions (aerobic storage at 4°C or 20°C). CONCLUSIONS Storage conditions only minimally affect recovery of C. difficile and its toxins in stool culture. A rapid GDH screening test and subsequent transfer of GDH-positive stool samples to reference laboratories for in-depth characterisation may improve our understanding of the epidemiology of C. difficile in the tropics.
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Affiliation(s)
- Sören L Becker
- Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Straße, Building 43, D-66421 Homburg/Saar, Germany Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland University of Basel, P.O. Box, CH-4003 Basel, Switzerland
| | - Justin K Chatigre
- Département de Médecine Interne, Hôpital Méthodiste de Dabou, Dabou, Côte d'Ivoire
| | - Jean T Coulibaly
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland University of Basel, P.O. Box, CH-4003 Basel, Switzerland Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, 02 BP 770, Abidjan 02, Côte d'Ivoire Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, 01 BP 1303, Abidjan 01, Côte d'Ivoire
| | - Pascal Mertens
- Coris BioConcept, Rue Jean Sonet 4A, B-5032 Gembloux, Belgium
| | - Bassirou Bonfoh
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, 01 BP 1303, Abidjan 01, Côte d'Ivoire
| | - Mathias Herrmann
- Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Straße, Building 43, D-66421 Homburg/Saar, Germany
| | - Ed J Kuijper
- Department of Medical Microbiology, Leiden University Medical Center, Albinusdreef 2, NL-2333 Leiden, The Netherlands
| | - Eliézer K N'Goran
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, 02 BP 770, Abidjan 02, Côte d'Ivoire Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, 01 BP 1303, Abidjan 01, Côte d'Ivoire
| | - Jürg Utzinger
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland University of Basel, P.O. Box, CH-4003 Basel, Switzerland
| | - Lutz von Müller
- Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Straße, Building 43, D-66421 Homburg/Saar, Germany
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CLINICAL AND EPIDEMIOLOGIC CONSIDERATIONS OF CLOSTRIDIUM DIFFICILE IN HARBOR SEALS (PHOCA VITULINA) AT A MARINE MAMMAL REHABILITATION CENTER. J Zoo Wildl Med 2015; 46:191-7. [PMID: 26056868 DOI: 10.1638/2014-0048r2.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Between 1998 and 2008, 15 cases of segmental to diffuse hemorrhagic to necrohemorrhagic enterocolitis were diagnosed in neonatal and weaned juvenile harbor seals (Phoca vitulina) presented from the Vancouver Aquarium Marine Mammal Rescue Centre for rehabilitation. Based on a combination of gross pathology, histopathology, bacterial isolation, and toxin testing, Clostridium difficile enterocolitis was diagnosed. Most pups were anorexic or inappetant and died acutely with few other premonitory signs. Due to ongoing clinical concerns and possible emergence of this pathogen at the facility, efforts to better characterize the disease and understand the epidemiology of C. difficile was initiated in 95 harbor seal pups presented for rehabilitation in a single stranding season. Fecal samples were collected on admission, following completion of antibiotic treatment, and also prerelease or postmortem. All samples were collected fresh and submitted either directly or stored frozen. Fecal samples were inoculated into selective media for culture and screened by enzyme-linked immunosorbant assay (ELISA) for C. difficile toxins A, B, or both. Results of the 95 seals in the study were as follows: on hospital admit 72 seals were sampled, 10 were culture positive, 12 were ELISA positive; following antibiotic therapy 46 seals were sampled noting three culture positive and nine ELISA positive; prior to release 58 seals were sampled noting zero culture positive and one ELISA positive; and on postmortem exam seven seals were sampled noting zero culture positive and two ELISA positive. Clostridium difficile was not deemed to be the cause of death in any of the animals. Although the exact mechanism of disease is unknown, this study suggests that C. difficile infection is not a significant cause of mortality and may be part of the normal flora in harbor seals undergoing rehabilitation. Morbidity and mortality from this bacterium can likely be minimized by judicious use of antibiotics, effective biosecurity-biocontainment protocols, and clean husbandry practices.
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Non-selective and selective enrichment media for the recovery of Clostridium difficile from chopped beef. J Microbiol Methods 2015; 109:20-4. [DOI: 10.1016/j.mimet.2014.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 12/01/2014] [Accepted: 12/01/2014] [Indexed: 01/05/2023]
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Comparison of BD Max Cdiff and GenomEra C. difficile molecular assays for detection of toxigenic Clostridium difficile from stools in conventional sample containers and in FecalSwabs. Eur J Clin Microbiol Infect Dis 2015; 34:1005-9. [DOI: 10.1007/s10096-015-2320-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 01/07/2015] [Indexed: 01/05/2023]
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Singh M, Vaishnavi C, Mahmood S, Kochhar R. Surveillance for Antibiotic Resistance in <i>Clostridium difficile</i> Strains Isolated from Patients in a Tertiary Care Center. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/aim.2015.55034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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An B, Kim H, Lee K. Evaluation of the Selective Enrichment Culture to Recover Clostridium difficile. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2014. [DOI: 10.15324/kjcls.2014.46.4.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Byoungrak An
- Department of Laboratory Medicine, Yongin Severance Hospital, Yongin, 449-930, Korea
| | - Heejung Kim
- Department of Laboratory Medicine, Yongin Severance Hospital, Yongin, 449-930, Korea
- Departments of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Kyungwon Lee
- Departments of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul 120-752, Korea
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Kim GH, Kim J, Pai H, Kang JO. Comparison of supplemented Brucella agar and modified Clostridium difficile agar for antimicrobial susceptibility testing of Clostridium difficile. Ann Lab Med 2014; 34:439-45. [PMID: 25368819 PMCID: PMC4215411 DOI: 10.3343/alm.2014.34.6.439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 04/16/2014] [Accepted: 08/27/2014] [Indexed: 12/18/2022] Open
Abstract
Background Antimicrobial susceptibility testing (AST) of Clostridium difficile is increasingly important because of the rise in resistant strains. The standard medium for the AST of C. difficile is supplemented Brucella agar (sBA), but we found that the growth of C. difficile on sBA was not optimal. Because active growth is critical for reliable AST, we developed a new, modified C. difficile (mCD) agar. C. difficile grew better on mCD agar than on sBA. Methods C. difficile isolates were collected from patients with healthcare-associated diarrhea. sBA medium was prepared according to the CLSI guidelines. Homemade mCD agar containing taurocholate, L-cysteine hydrochloride, and 7% horse blood was used. For 171 C. difficile isolates, we compared the agar dilution AST results from mCD agar with those from sBA. Results No significant differences were observed in the 50% minimal inhibitory concentration (MIC50) and 90% minimal inhibitory concentration (MIC90) of clindamycin (CLI), metronidazole (MTZ), moxifloxacin (MXF), piperacillin-tazobactam (PTZ), and rifaximin (RIX), but the values for vancomycin (VAN) were two-fold higher on mCD agar than on sBA. The MICs of CLI, MXF, and RIX were in 100% agreement within two-fold dilutions, but for MTZ, VAN, and PTZ, 13.7%, 0.6%, and 3.1% of the isolates, respectively, were outside the acceptable range. Conclusions The MIC ranges, MIC50 and MIC90, were acceptable when AST was performed on mCD agar. Thus, mCD agar could be used as a substitute medium for the AST of C. difficile.
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Affiliation(s)
- Gye Hyeong Kim
- Department of Laboratory Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jieun Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jung Oak Kang
- Department of Laboratory Medicine, Hanyang University College of Medicine, Seoul, Korea
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Spigaglia P, Drigo I, Barbanti F, Mastrantonio P, Bano L, Bacchin C, Puiatti C, Tonon E, Berto G, Agnoletti F. Antibiotic resistance patterns and PCR-ribotyping of Clostridium difficile strains isolated from swine and dogs in Italy. Anaerobe 2014; 31:42-6. [PMID: 25316022 DOI: 10.1016/j.anaerobe.2014.10.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/24/2014] [Accepted: 10/05/2014] [Indexed: 01/05/2023]
Abstract
Recent studies suggest animals, in particular farm and companion animals, as possible reservoir for Clostridium difficile human pathogenic strains. The aim of this study was to give a first characterization of C. difficile isolates from Italian swine and dogs. In total, 10 different PCR-ribotypes were identified among porcine strains and six among canine strains. The predominant type found among porcine strains was 078 (50%), whereas the most frequently detected among canine strains was the non-toxinogenic 010 (64%). Considering the CLSI breakpoints, 60% of porcine isolates was resistant to ERY, 35% to MXF, 15% to CLI, 5% to RIF, and none to MTZ or VAN. Among dogs, 51% of strains was resistant to CLI, 46% to ERY, 21% to MTZ and 5% to MXF or RIF, and none to VAN. Five porcine strains (10%) and 9 canine isolates (41%) were MDR. Interestingly, 8 MDR canine strains were highly resistant to MTZ, with MICs ≥32 mg/L. Considering the EUCAST cut-off for MTZ (MIC >2 mg/L), 13 canine isolates and one porcine strain were found with reduced susceptibility to MTZ (MICs ranging from 3 to ≥256 mg/L). Swine and canine strains showing resistance or reduced susceptibility to MTZ belonged to PCR-ribotype 010 and 078. These PCR-ribotypes have been associated to reduced susceptibility to MTZ also in human, suggesting a potential risk for the emergence of C. difficile strains resistant to the current first-line antibiotic for CDI treatment. The agar incorporation method (AIM) was confirmed as the best method to detect C. difficile strains with this phenotype also after strains manipulations. The results obtained add further evidences about the possible role of animals as source of MDR C. difficile strains and reservoir of antibiotic resistance determinants.
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Affiliation(s)
- Patrizia Spigaglia
- Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità, Rome, Italy.
| | - Ilenia Drigo
- Special Bacteriology Laboratory, Istituto Zooprofilattico Sperimentale delle Venezie, Treviso, Italy
| | - Fabrizio Barbanti
- Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Paola Mastrantonio
- Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Luca Bano
- Special Bacteriology Laboratory, Istituto Zooprofilattico Sperimentale delle Venezie, Treviso, Italy
| | - Cosetta Bacchin
- Special Bacteriology Laboratory, Istituto Zooprofilattico Sperimentale delle Venezie, Treviso, Italy
| | - Cinzia Puiatti
- Special Bacteriology Laboratory, Istituto Zooprofilattico Sperimentale delle Venezie, Treviso, Italy
| | - Elena Tonon
- Special Bacteriology Laboratory, Istituto Zooprofilattico Sperimentale delle Venezie, Treviso, Italy
| | - Giacomo Berto
- Special Bacteriology Laboratory, Istituto Zooprofilattico Sperimentale delle Venezie, Treviso, Italy
| | - Fabrizio Agnoletti
- Special Bacteriology Laboratory, Istituto Zooprofilattico Sperimentale delle Venezie, Treviso, Italy
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Lister M, Stevenson E, Heeg D, Minton NP, Kuehne SA. Comparison of culture based methods for the isolation of Clostridium difficile from stool samples in a research setting. Anaerobe 2014; 28:226-9. [PMID: 25038491 DOI: 10.1016/j.anaerobe.2014.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 06/10/2014] [Accepted: 07/07/2014] [Indexed: 01/05/2023]
Abstract
Effective isolation of Clostridium difficile from stool samples is important in the research setting, especially where low numbers of spores/vegetative cells may be present within a sample. In this study, three protocols for stool culture were investigated to find a sensitive, cost effective and timely method of C. difficile isolation. For the initial enrichment step, the effectiveness of two different rich media, cycloserine-cefoxitin fructose broth (CCFB) and cycloserine-cefoxitin mannitol broth with taurocholate and lysozyme (CCMB-TAL) were compared. For the comparison of four different, selective solid media; Cycloserine-cefoxitin fructose agar (CCFA), Cycloserine-cefoxitin egg yolk agar (CCEY), ChromID C. difficile and tryptone soy agar (TSA) with 5% sheep's blood with and without preceding broth enrichment were used. As a means to enable differentiation between C. difficile and other fecal flora, the effectiveness of the inclusion of a pH indictor (1% Neutral Red), was also evaluated. The data derived indicated that CCFB is more sensitive than CCMB-TAL, however, the latter had an improved recovery rate. A broth enrichment step had a reduced sensitivity over direct plating. ChromID C. difficile showed the best recovery rate whereas CCEY egg yolk agar was the most sensitive of the four. The addition of 1% Neutral Red did not show sufficient colour change when added to CCEY egg yolk agar to be used as a differential medium. For a low cost, timely and sensitive method of isolating C. difficile from stool samples we recommend direct plating onto CCEY egg yolk agar after heat shock.
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Affiliation(s)
- Michelle Lister
- Clostridia Research Group, Centre for Biomolecular Sciences, School of Life Sciences, Nottingham Digestive Diseases Centre, NIHR Biomedical Research Unit, The University of Nottingham, Nottingham, United Kingdom
| | - Emma Stevenson
- Clostridia Research Group, Centre for Biomolecular Sciences, School of Life Sciences, Nottingham Digestive Diseases Centre, NIHR Biomedical Research Unit, The University of Nottingham, Nottingham, United Kingdom
| | - Daniela Heeg
- Clostridia Research Group, Centre for Biomolecular Sciences, School of Life Sciences, Nottingham Digestive Diseases Centre, NIHR Biomedical Research Unit, The University of Nottingham, Nottingham, United Kingdom
| | - Nigel P Minton
- Clostridia Research Group, Centre for Biomolecular Sciences, School of Life Sciences, Nottingham Digestive Diseases Centre, NIHR Biomedical Research Unit, The University of Nottingham, Nottingham, United Kingdom
| | - Sarah A Kuehne
- Clostridia Research Group, Centre for Biomolecular Sciences, School of Life Sciences, Nottingham Digestive Diseases Centre, NIHR Biomedical Research Unit, The University of Nottingham, Nottingham, United Kingdom.
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Comparison of FecalSwab and ESwab devices for storage and transportation of Diarrheagenic bacteria. J Clin Microbiol 2014; 52:2334-9. [PMID: 24740083 DOI: 10.1128/jcm.00539-14] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Using a collection (n = 12) of ATCC and known stock isolates, as well as 328 clinical stool specimens, we evaluated the ESwab and the new FecalSwab liquid-based microbiology (LBM) devices for storing and transporting diarrheagenic bacteria. The stock isolates were stored in these swab devices up to 48 h at refrigeration (4°C) or room (∼25°C) temperature and up to 3 months at -20°C or -70°C. With the clinical stool specimens, the performances of the ESwab and FecalSwab were compared to those of routinely used transport systems (Amies gel swabs and dry containers). At a refrigeration temperature, all isolates survived in FecalSwab up to 48 h, while in ESwab, only 10 isolates (83.3%) out of 12 survived. At -70°C, all isolates in FecalSwab were recovered after 3 months of storage, whereas in ESwab, none of the isolates were recovered. At -20°C, neither of the swab devices preserved the viability of stock isolates after 2 weeks of storage, and at room temperature, 7 (58.3%) of the stock isolates were recovered in both transport devices after 48 h. Of the 328 fecal specimens, 44 (13.4%) were positive for one of the common diarrheagenic bacterial species with all transport systems used. Thus, the suitability of the ESwab and FecalSwab devices for culturing fresh stools was at least equal to those of the Amies gel swabs and dry containers. Although the ESwab was shown to be an option for collecting and transporting fecal specimens, the FecalSwab device had clearly better preserving properties under different storage conditions.
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Kim H, Kim WH, Kim M, Jeong SH, Lee K. Evaluation of a rapid membrane enzyme immunoassay for the simultaneous detection of glutamate dehydrogenase and toxin for the diagnosis of Clostridium difficile infection. Ann Lab Med 2014; 34:235-9. [PMID: 24790912 PMCID: PMC3999323 DOI: 10.3343/alm.2014.34.3.235] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 11/14/2013] [Accepted: 03/03/2014] [Indexed: 12/15/2022] Open
Abstract
We evaluated the new C. DIFF QUIK CHEK COMPLETE (CD COMPLETE; TechLab, USA), which is a rapid membrane enzyme immunoassay that uses a combination of glutamate dehydrogenase (GDH) antigen and toxin A and B detection. A total of 608 consecutive loose stool specimens collected from the patients with suspected Clostridium difficile infection (CDI) from August to December 2012 were subjected to the CD COMPLETE and VIDAS Clostridium difficile A & B (VIDAS CDAB; bioMérieux, France). Their performances were compared with a toxigenic culture as a reference. Stool specimens that were culture-negative and CD COMPLETE- or VIDAS CDAB-positive were analyzed by using an enrichment procedure. In comparison to the toxigenic cultures, sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) were 63.6%, 98.0%, 76.1%, and 96.4%, respectively, for the CD COMPLETE-toxin and 75.5%, 97.4%, 72.5%, and 97.8%, respectively, for the VIDAS CDAB. In comparison to the enriched C. difficile cultures, the sensitivity, specificity, PPV, and NPV for the CD COMPLETE-GDH were 91.0%, 92.4%, 70.5%, and 98.1%, respectively. The CD COMPLETE is a reliable method for the diagnosis of CDI and provides greater sensitivity than toxin enzyme immunoassay alone. Furthermore, the CD COMPLETE-GDH has advantages over direct culture in detecting C. difficile.
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Affiliation(s)
- Heejung Kim
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Wan Hee Kim
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Myungsook Kim
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Seok Hoon Jeong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Kyungwon Lee
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
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Diagnosis of Clostridium difficile infection: an ongoing conundrum for clinicians and for clinical laboratories. Clin Microbiol Rev 2014; 26:604-30. [PMID: 23824374 DOI: 10.1128/cmr.00016-13] [Citation(s) in RCA: 277] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Clostridium difficile is a formidable nosocomial and community-acquired pathogen, causing clinical presentations ranging from asymptomatic colonization to self-limiting diarrhea to toxic megacolon and fulminant colitis. Since the early 2000s, the incidence of C. difficile disease has increased dramatically, and this is thought to be due to the emergence of new strain types. For many years, the mainstay of C. difficile disease diagnosis was enzyme immunoassays for detection of the C. difficile toxin(s), although it is now generally accepted that these assays lack sensitivity. A number of molecular assays are commercially available for the detection of C. difficile. This review covers the history and biology of C. difficile and provides an in-depth discussion of the laboratory methods used for the diagnosis of C. difficile infection (CDI). In addition, strain typing methods for C. difficile and the evolving epidemiology of colonization and infection with this organism are discussed. Finally, considerations for diagnosing C. difficile disease in special patient populations, such as children, oncology patients, transplant patients, and patients with inflammatory bowel disease, are described. As detection of C. difficile in clinical specimens does not always equate with disease, the diagnosis of C. difficile infection continues to be a challenge for both laboratories and clinicians.
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Shin BM, Lee EJ. Comparison of ChromID agar and Clostridium difficile selective agar for effective isolation of C. difficile from stool specimens. Ann Lab Med 2013; 34:15-9. [PMID: 24422190 PMCID: PMC3885767 DOI: 10.3343/alm.2014.34.1.15] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 05/24/2013] [Accepted: 07/15/2013] [Indexed: 01/05/2023] Open
Abstract
Background ChromID Clostridium difficile agar (IDCd; bioMérieux SA, France) is a recently developed chromogenic medium for rapid and specific isolation of C. difficile. We compared the performance of IDCd with that of Clostridium difficile Selective Agar (CDSA). Methods A total of 530 fresh stool specimens were collected from patients with clinical signs compatible with C. difficile infection, and cultures for C. difficile were performed on IDCd and CDSA. C. difficile colonies were identified by spore staining, odor, use of an ANI identification test kit (bioMérieux SA), and multiplex PCR for tcdA, tcdB, and tpi. Results The concordance rate between IDCd and CDSA was 90.6% (480/530). The positivity rates on IDCd on days 1 and 2 (55.6% and 85.0%, respectively) were significantly higher than those on CDSA (19.4% and 75.6%, respectively) (P<0.001 for day 1 and P=0.02 for day 2), but the detection rates on IDCd and CDSA on day 3 were not different (89.4% vs. 82.8%, P=0.0914). On day 3, the recovery rates for non-C. difficile isolates on IDCd and CDSA were 30.2% (160/530) and 22.1% (117/530), respectively (P=0.0075). Clostridium spp. other than C. difficile were the most prevalent non-C. difficile isolates on both media. Conclusions The culture positivity rates on IDCd and CDSA were not different on day 3 but IDCd may allow for rapid and sensitive detection of C. difficile within 2 days of cultivation.
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Affiliation(s)
- Bo-Moon Shin
- Department of Laboratory Medicine, Inje University, Sanggye Paik Hospital, Seoul, Korea
| | - Eun Joo Lee
- Department of Laboratory Medicine, Inje University, Sanggye Paik Hospital, Seoul, Korea
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Monteiro AA, Pires RN, Baethgen LF, Carneiro LC, Tavares RG, Caierão J, Park S, Perlin DS, Rodrigues Filho EM, Pasqualotto AC. Discrepancies among three laboratory methods for Clostridium difficile detection and a proposal for their optimal use. FEMS Microbiol Lett 2013; 350:133-7. [PMID: 24236508 DOI: 10.1111/1574-6968.12330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 11/07/2013] [Indexed: 11/30/2022] Open
Abstract
Clostridium difficile is the major cause of nosocomial diarrhoea. Several detection methods are available for the laboratory diagnosis of C. difficile, but these vary in terms of sensitivity and specificity. In this study, we compared the performance of three following laboratory tests to detect C. difficile: in-house real-time PCR aiming for toxin B gene (tcdB), EIA for detection of toxins A and B (Premier Toxins A & B) and C. difficile culture in selective medium (bioMerieux). Our results were grouped into three categories as follows: (1) C. difficile-associated diarrhoea (CDAD); (2) asymptomatic carriers; and (3) negative results. Among the 113 patients included in the study, 9 (8.0%) were classified as CDAD, 19 (16.8%) were asymptomatic carriers, 76 (67.2%) had negative results and 9 (8.0%) could not be categorized (positive test for C. difficile toxins only). PCR was found to be the most sensitive diagnostic test in our study, with the potential to be used as a screening method for C. difficile colonization/CDAD. Diagnosis of CDAD would be better performed by a combination of PCR and EIA tests.
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Is the prevalence of Clostridium difficile in animals underestimated? Vet J 2013; 197:694-8. [DOI: 10.1016/j.tvjl.2013.03.053] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 02/18/2013] [Accepted: 03/07/2013] [Indexed: 11/18/2022]
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Hirvonen JJ, Mentula S, Kaukoranta SS. Evaluation of a new automated homogeneous PCR assay, GenomEra C. difficile, for rapid detection of Toxigenic Clostridium difficile in fecal specimens. J Clin Microbiol 2013; 51:2908-12. [PMID: 23804386 PMCID: PMC3754623 DOI: 10.1128/jcm.01083-13] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 06/19/2013] [Indexed: 12/18/2022] Open
Abstract
We evaluated a new automated homogeneous PCR assay to detect toxigenic Clostridium difficile, the GenomEra C. difficile assay (Abacus Diagnostica, Finland), with 310 diarrheal stool specimens and with a collection of 33 known clostridial and nonclostridial isolates. Results were compared with toxigenic culture results, with discrepancies being resolved by the GeneXpert C. difficile PCR assay (Cepheid). Among the 80 toxigenic culture-positive or GeneXpert C. difficile assay-positive fecal specimens, 79 were also positive with the GenomEra C. difficile assay. Additionally, one specimen was positive with the GenomEra assay but negative with the confirmatory methods. Thus, the sensitivity and specificity were 98.8% and 99.6%, respectively. With the culture collection, no false-positive or -negative results were observed. The analytical sensitivity of the GenomEra C. difficile assay was approximately 5 CFU per PCR test. The short hands-on (<5 min for 1 to 4 samples) and total turnaround (<1 h) times, together with the high positive and negative predictive values (98.8% and 99.6%, respectively), make the GenomEra C. difficile assay an excellent option for toxigenic C. difficile detection in fecal specimens.
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Affiliation(s)
- Jari J Hirvonen
- Department of Clinical Microbiology, Vaasa Central Hospital, Vaasa, Finland.
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Leis JA, Gold WL, Ng J, Hirji Z, Pillai DR, Broukhanski G, Raggiunti P, Hota S, McGeer A, Poutanen SM. Indeterminate tcdB using a Clostridium difficile PCR assay: a retrospective cohort study. BMC Infect Dis 2013; 13:324. [PMID: 23865713 PMCID: PMC3718660 DOI: 10.1186/1471-2334-13-324] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 07/08/2013] [Indexed: 01/05/2023] Open
Abstract
Background C. difficile (CD) real-time polymerase chain reaction (PCR) for toxin B gene (tcdB) is more sensitive, and reduces turnaround time when compared to toxin immunoassay. We noted typical amplification curves with high tcdB cycle thresholds (Ct) and low endpoints (Ept) that are labeled negative by the Xpert® C. difficile assay (Cepheid) and undertook this study to determine their significance. Methods We defined an indeterminate CD assay result as detection of a typical PCR amplification curve with an Ept >10 that was interpreted as negative by the Xpert® assay. Samples with indeterminate Xpert® result were collected for 5 months and retested by Xpert®, cultured for toxigenic CD, and isolates subjected to PCR ribotyping, detection of toxin genes and multilocus variable-number tandem repeat analysis (MLVA) typing. Chart reviews were completed to assess if patients met the Society of Healthcare Epidemiology of America and the Infectious Diseases Society of America CD infection (CDI) clinical case definition. Illness severity was compared with tcdB Ct and culture results. Results During the 5-month study period, 48/3620 (1%) of specimens were indeterminate and 387/3620 (11%) were positive. Of the 48 patients with indeterminate results, 39 (81%) met the clinical case definition of CDI, and 7 of these (18%) met criteria for severe CDI. Toxigenic stool cultures were positive for 86% (6/7) of patients with severe CDI, 19% (6/32) of patients with non-severe CDI, and 44% (4/9) of patients who did not meet the clinical case definition of CDI (p = 0.002). Lower tcdB Ct and higher Ept were associated with greater likelihood of toxigenic culture positivity (p = 0.03) and more severe symptoms (p = 0.06). Indeterminate results were not associated with a particular technologist or instrument module, or CD strain type. Conclusions A subset of specimens (1%) using the Xpert® C. difficile assay have typical amplification curves and are interpreted as negative. At least one-third of these results are associated with positive CD culture. The mechanism of these indeterminate results is not technique-related, equipment-related, or due to particular CD strains. Clinicians should be aware that even PCR testing has the potential to miss CDI cases and further highlights the importance of clinical context when interpreting results.
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Affiliation(s)
- Jerome A Leis
- Division of Infectious Diseases, Department of Medicine, University Health Network/Mount Sinai Hospital, Toronto, ON, Canada.
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Evaluation of the fully automated BD MAX Cdiff and Xpert C. difficile assays for direct detection of Clostridium difficile in stool specimens. J Clin Microbiol 2013; 51:1906-8. [PMID: 23515539 DOI: 10.1128/jcm.00344-13] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We evaluated the fully automated molecular BD MAX Cdiff assay (BD Diagnostics) and the Xpert C. difficile test (Cepheid) for rapid detection of Clostridium difficile infection. Culture was done on chromogenic agar followed by matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry identification and toxin detection. Repeat testing was required for 1.8% and 6.0% of the BD MAX and Xpert tests, respectively. Sensitivities, specificities, positive predictive values (PPV), and negative predictive values (NPV) were 90.5%, 97.9%, 89.3%, and 98.1%, respectively, for BD MAX and 97.3%, 97.9%, 90.0%, and 99.5%, respectively, for Xpert.
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Hink T, Burnham CAD, Dubberke ER. A systematic evaluation of methods to optimize culture-based recovery of Clostridium difficile from stool specimens. Anaerobe 2012; 19:39-43. [PMID: 23247066 DOI: 10.1016/j.anaerobe.2012.12.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 11/21/2012] [Accepted: 12/05/2012] [Indexed: 02/06/2023]
Abstract
With the increasing prevalence of Clostridium difficile infection among hospitalized patients, a clear understanding of C. difficile epidemiology is needed to evaluate current prevention policies, and to create new and effective policies. To determine the epidemiology of C. difficile, the most sensitive methods for detection of C. difficile are required. The purpose of this study was to systematically assess multiple methods to determine the most sensitive method to recover C. difficile from stool and rectal swabs. Stool samples from healthy asymptomatic individuals that were collected and confirmed to be culture negative for C. difficile were spiked with known concentrations of C. difficile ranging from 10(4) CFU of C. difficile per ml of stool to 10 CFU per ml. Two sets of experiments (A and B) were performed and each involved multiple combinations of untreated and treated stool/rectal swab specimens and selective and non-selective broth and agar. Overall, recovery of C. difficile was increased with the use of an initial broth enrichment followed by plating to solid medium. The most sensitive method of C. difficile detection for both stools and swab specimens was heat shock prior to inoculation of cycloserine-cefoxitin mannitol broth with taurocholate lysozyme cysteine (CCMB, Anaerobe Systems, Morgan Hill, CA) followed by isolation from pre-reduced TSA II with 5% sheep blood (BAP, BBL BD and Co., Sparks, MD). Identifying the most sensitive method of recovery will allow for further study of asymptomatic C. difficile carriers and their role in the epidemiology of C. difficile.
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Affiliation(s)
- Tiffany Hink
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
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Dumyati G, Stevens V, Hannett GE, Thompson AD, Long C, Maccannell D, Limbago B. Community-associated Clostridium difficile infections, Monroe County, New York, USA. Emerg Infect Dis 2012; 18:392-400. [PMID: 22377231 PMCID: PMC3309637 DOI: 10.3201/eid1803.102023] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Judicious use of antimicrobial drugs will reduce infections.
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Affiliation(s)
- Ghinwa Dumyati
- Community Health, University of Rochester, Rochester, NY 14607, USA.
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An evaluation of the VIDAS CDAB assay for the detection of Clostridium difficile infection in a clinical laboratory. Pathology 2012; 44:379-81. [PMID: 22531349 DOI: 10.1097/pat.0b013e328353be1a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mattner F, Winterfeld I, Mattner L. Diagnosing toxigenic Clostridium difficile: New confidence bounds show culturing increases sensitivity of the toxin A/B enzyme immunoassay and refute gold standards. ACTA ACUST UNITED AC 2012; 44:578-85. [DOI: 10.3109/00365548.2012.655772] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Carroll KC, Bartlett JG. Biology of Clostridium difficile: implications for epidemiology and diagnosis. Annu Rev Microbiol 2012; 65:501-21. [PMID: 21682645 DOI: 10.1146/annurev-micro-090110-102824] [Citation(s) in RCA: 172] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Clostridium difficile is an anaerobic, spore-forming, gram-positive rod that causes a spectrum of antibiotic-associated colitis through the elaboration of two large clostridial toxins and other virulence factors. Since its discovery in 1978 as the agent responsible for pseudomembranous colitis, the organism has continued to evolve into an adaptable, aggressive, hypervirulent strain. Advances in molecular methods and improved animal models have facilitated an understanding of how this organism survives in the environment, adapts to the gastrointestinal tract of animals and humans, and accomplishes its unique pathogenesis. The advances in microbiology have been accompanied by some important clinical observations including increased rates of C. difficile infection, increased virulence, and multiple outbreaks. The major new risk is fluoroquinolone use; there is also an association with proton pump inhibitors and increased recognition of cases in outpatients, pediatric patients, and patients without recent antibiotic use. The combination of more aggressive strains with mobile genomes in a setting of an expanded pool of individuals at risk has refocused attention on and challenged assumptions regarding diagnostic gold standards. Future research is likely to build upon the advancements in phylogenetics to create novel strategies for diagnosis, treatment, and prevention.
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Affiliation(s)
- Karen C Carroll
- Division of Medical Microbiology, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21205, USA.
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McNamara SE, Abdujamilova N, Somsel P, Gordoncillo MJ, DeDecker JM, Bartlett PC. Carriage of Clostridium difficile and other enteric pathogens among a 4-H avocational cohort. Zoonoses Public Health 2011; 58:192-9. [PMID: 20529211 DOI: 10.1111/j.1863-2378.2010.01338.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Clostridium difficile (CD), Salmonella, Campylobacter and enterohemorrhagic Escherichia coli (EHEC) are major causes of morbidity in a variety of enteric diseases in humans and animals, but subclinical carriage in both is probably more common than are clinical cases. Little is known regarding the prevalence of these pathogens in animals raised for exhibit at Michigan county fairs or the frequency with which Michigan citizens raising these animals may have been subclinically colonized. To address these issues, 361 fecal specimens from 158 humans and 203 of their farm animals were cultured for CD, Salmonella and Campylobacter. Additionally, 50 people and their cattle were tested for EHEC. No EHEC, Salmonella or Campylobacter were detected. However, 16 specimens (4.4%) were positive for CD: 13 humans, two horses and one pig. None of the farm animal specimens submitted by any of the 13 CD-positive humans were positive for CD. Strain characterization [toxinotype, pulsed-field gel electrophoresis (PFGE)] demonstrated that the human CD isolates were similar to what has been reported previously in the general US population. We conclude that horses and farm animals (cattle, sheep, goats and swine) at 1-2 months before market weight showed no evidence of wide-spread carriage of the common enteric pathogens, including the recently reported CD toxinotype V. These results provide no support to the hypothesis that 4-H members or others visiting county fair animal husbandry projects in these counties may be at increased risk for acquisition of CD, Salmonella, Campylobacter or EHEC from animals.
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Affiliation(s)
- S E McNamara
- Infectious Diseases Division, Bureau of Laboratories, Michigan Department of Community Health, Lansing, MI, USA
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Rodriguez-Palacios A, Koohmaraie M, LeJeune JT. Prevalence, enumeration, and antimicrobial agent resistance of Clostridium difficile in cattle at harvest in the United States. J Food Prot 2011; 74:1618-24. [PMID: 22004807 DOI: 10.4315/0362-028x.jfp-11-141] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
To assess the potential for food contamination with Clostridium difficile from food animals, we conducted a cross-sectional fecal prevalence study in 944 randomly selected cattle harvested at seven commercial meat processing plants, representing four distant regions (median distance of 1,500 km) of the United States. In all, 944 animals were sampled in the summer of 2008. C. difficile was isolated from 1.8% (17 of 944) of cattle, with median fecal shedding concentration of 2.2 log CFU/g (range = 1.6 to 4.8, 95% confidence interval = 1.6, 4.3). Toxigenic C. difficile isolates were recovered from only four (0.4%) cattle. One of these isolates was emerging PCR ribotype 078/toxinotype V. The remaining toxigenic isolates were toxinotype 0, one of which was an isolate with resistance to linezolid, clindamycin, and moxifloxacin (by the E-test). All isolates were susceptible to vancomycin, metronidazole, and tigecycline, but the MICs against linezolid were as high as the highest reported values for human-derived isolates. The source of the linezolid-clindamycin-moxifloxacin resistance in a toxigenic C. difficile isolate from cattle is uncertain. However, since the use of these three antimicrobial agents in cattle is not allowed in North America, it is possible that resistance originated from an environmental source, from other species where those antimicrobial agents are used, or transferred from other intestinal bacteria. This study confirms that commercial cattle can carry epidemiologically relevant C. difficile strains at the time of harvest, but the prevalence at the time they enter the food chain is low.
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Affiliation(s)
- Alexander Rodriguez-Palacios
- Food Animal Health Research Program, College of Food, Agricultural, and Environmental Sciences, Ohio Agricultural Research and Development Center, The Ohio State University, Wooster, Ohio 44691, USA
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