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Increased environmental sample area and recovery of Clostridium difficile spores from hospital surfaces by quantitative PCR and enrichment culture

  • Kevin Antoine Brown (a1) (a2), Laura K. MacDougall (a1), Kim Valenta (a3), Andrew Simor (a4) (a5), Jennie Johnstone (a1) (a5), Samira Mubareka (a4) (a5), George Broukhanski (a1), Gary Garber (a1) (a5) (a6), Allison McGeer (a5) (a7) and Nick Daneman (a1) (a4) (a5)...

Abstract

Objective

Clostridium difficile spores play an important role in transmission and can survive in the environment for several months. Optimal methods for measuring environmental C. difficile are unknown. We sought to determine whether increased sample surface area improved detection of C. difficile from environmental samples.

Setting

Samples were collected from 12 patient rooms in a tertiary-care hospital in Toronto, Canada.

Methods

Samples represented small surface-area and large surface-area floor and bedrail pairs from single-bed rooms of patients with low (without prior antibiotics), medium (with prior antibiotics), and high (C. difficile infected) shedding risk. Presence of C. difficile in samples was measured using quantitative polymerase chain reaction (qPCR) with targets on the 16S rRNA and toxin B genes and using enrichment culture.

Results

Of the 48 samples, 64·6% were positive by 16S qPCR (geometric mean, 13·8 spores); 39·6% were positive by toxin B qPCR (geometric mean, 1·9 spores); and 43·8% were positive by enrichment culture. By 16S qPCR, each 10-fold increase in sample surface area yielded 6·6 times (95% CI, 3·2–13) more spores. Floor surfaces yielded 27 times (95% CI, 4·9–181) more spores than bedrails, and rooms of C. difficile–positive patients yielded 11 times (95% CI, 0·55–164) more spores than those of patients without prior antibiotics. Toxin B qPCR and enrichment culture returned analogous findings.

Conclusions

Clostridium difficile spores were identified in most floor and bedrail samples, and increased surface area improved detection. Future research aiming to understand the role of environmental C. difficile in transmission should prefer samples with large surface areas.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. All rights reserved.

Corresponding author

Author for correspondence: Kevin Antoine Brown, Public Health Ontario, 480 University Ave, #300, Toronto, ON M5G1V2, Canada. E-mail: kevin.brown@oahpp.ca or kevin.brown@utoronto.ca

Footnotes

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Cite this article: Brown KA, et al. (2018). Increased environmental sample area and recovery of Clostridium difficile spores from hospital surfaces by quantitative PCR and enrichment culture. Infection Control & Hospital Epidemiology 2018, 39, 917–923. doi:10.1017/ice.2018.103

Footnotes

References

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