title: Triggering germination represents a novel strategy to enhance killing of Clostridium difficile spores.
abstract: BACKGROUND
  Clostridium difficile is an anaerobic, spore-forming bacterium that is the most common cause of healthcare-associated diarrhea in developed countries. Control of C. difficile is challenging because the spores are resistant to killing by alcohol-based hand hygiene products, antimicrobial soaps, and most disinfectants. Although initiation of germination has been shown to increase susceptibility of spores of other bacterial species to radiation and heat, it was not known if triggering of germination could be a useful strategy to increase susceptibility of C. difficile spores to radiation or other stressors.
  
  
  RESULTS
  Here, we demonstrated that exposure of dormant C. difficile spores to a germination solution containing amino acids, minerals, and taurocholic acid resulted in initiation of germination in room air. Germination of spores in room air resulted in significantly enhanced killing by ultraviolet-C (UV-C) radiation and heat. On surfaces in hospital rooms, application of germination solution resulted in enhanced eradication of spores by UV-C administered by an automated room decontamination device. Initiation of germination under anaerobic, but not aerobic, conditions resulted in increased susceptibility to killing by ethanol, suggesting that exposure to oxygen might prevent spores from progressing fully to outgrowth. Stimulation of germination also resulted in reduced survival of spores on surfaces in room air, possibly due to increased susceptibility to stressors such as oxygen and desiccation.
  
  
  CONCLUSIONS
  Taken together, these data demonstrate that stimulation of germination could represent a novel method to enhance killing of spores by UV-C, and suggest the possible application of this strategy as a means to enhance killing by other agents.
authors.affiliation: Research Service, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, United States of America.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Nerandzic
authors.forename: Curtis J
authors.initials: CJ
authors.lastname: Donskey
mesh_terms: D000388:Air; D000438:Alcohols / Q000494:pharmacology; D000693:Anaerobiosis; D016360:Clostridioides difficile / Q000187:drug effects / Q000254:growth & development* / Q000528:radiation effects; D004203:Disinfection / Q000379:methods*; D024881:Drug Resistance, Bacterial; D016983:Enterococcus / Q000187:drug effects / Q000528:radiation effects; D006761:Hospitals; D006358:Hot Temperature; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000528:radiation effects; D011829:Radiation Dosage; D012996:Solutions; D013171:Spores, Bacterial / Q000187:drug effects / Q000254:growth & development / Q000528:radiation effects; D013997:Time Factors; D014466:Ultraviolet Rays; D014640:Vancomycin / Q000494:pharmacology
chemical_list: D000438:Alcohols; D012996:Solutions; D014640:Vancomycin
references.citation: Lett Appl Microbiol. 2002;34(2):86-90
references.pmid: 11849500
references.citation: N Engl J Med. 2005 Dec 8;353(23):2442-9
references.pmid: 16322602
references.citation: Clin Infect Dis. 2007 Oct 15;45(8):992-8
references.pmid: 17879913
references.citation: Antonie Van Leeuwenhoek. 1956;22(4):337-49
references.pmid: 13395344
references.citation: Am J Infect Control. 2009 Feb;37(1):15-9
references.pmid: 19171247
references.citation: Clin Infect Dis. 2008 Jan 15;46 Suppl 1:S43-9
references.pmid: 18177221
references.citation: J Antimicrob Chemother. 2008 Sep;62(3):522-5
references.pmid: 18544601
references.citation: Appl Microbiol. 1968 Jan;16(1):82-9
references.pmid: 4295179
references.citation: Infect Control Hosp Epidemiol. 2009 Oct;30(10):959-63
references.pmid: 19712033
references.citation: N Engl J Med. 2005 Dec 8;353(23):2433-41
references.pmid: 16322603
references.citation: J Appl Bacteriol. 1970 Mar;33(1):34-49
references.pmid: 4246071
references.citation: J Bacteriol. 2009 Mar;191(6):1787-97
references.pmid: 19136594
references.citation: Biochim Biophys Acta. 1956 Nov;22(2):241-6
references.pmid: 13382838
references.citation: Lancet. 2000 Oct 14;356(9238):1324
references.pmid: 11073024
references.citation: J Clin Microbiol. 2009 Feb;47(2):397-400
references.pmid: 19073869
references.citation: Curr Opin Microbiol. 2003 Dec;6(6):550-6
references.pmid: 14662349
references.citation: Food Microbiol. 2009 May;26(3):272-7
references.pmid: 19269568
references.citation: Infect Control Hosp Epidemiol. 2009 Jun;30(6):507-14
references.pmid: 19379098
references.citation: J Bacteriol. 1974 Oct;120(1):59-65
references.pmid: 4213680
references.citation: J Appl Bacteriol. 1968 Sep;31(3):357-66
references.pmid: 4972401
references.citation: Infect Control Hosp Epidemiol. 2007 Aug;28(8):920-5
references.pmid: 17620238
references.citation: J Bacteriol. 1970 May;102(2):590-2
references.pmid: 4911549