title: Clostridium difficile in retail baskets, trolleys, conveyor belts, and plastic bags in Saudi Arabia.
abstract: OBJECTIVE
  To determine Clostridium difficile (C. difficile) prevalence on retail surfaces and shoppers plastic bags.
  
  
  METHODS
  From 20 June to 10 August 2011, in a cross-sectional epidemiological study, 17 supermarkets from 2 cities, Albaha and Altaif, Saudi Arabia were sampled. A total of 800 samples, which comprised 200 samples per surveyed surface, were studied. These included baskets, trolleys, conveyer belts, and outgoing shoppers' plastic bags. Clostridium difficile strains were isolated. The isolates were characterized using ribotyping and  polymerase chain reaction for the detection of toxin A (tcdA), toxin B (tcdB), binary toxin (cdtB), and toxin C (tcdC) genes. Susceptibility to antibiotics was determined on a Muller-Hinton agar with 5% sheep blood agar using E-tests.
  
  
  RESULTS
  Overall, the C. difficile prevalence on sampled surfaces was 0.75%. The highest prevalence was found on retail baskets and trolleys, followed by plastic bags. A total of 5 different ribotypes were identified. Alterations in tcdC were detected in ribotype 027 and BT1. All the identified isolates were susceptible to vancomycin, but resistant to levofloxacin.
  
  
  CONCLUSIONS
  In this study, C. difficile was present at a rate of 0.75% on supermarket surfaces. Spore disinfection of implicated surfaces may be necessary to control any community-acquired infections caused by this pathogen.
authors.affiliation: Faculty of Applied Medical Sciences, Albaha University, PO Box 1988, Albaha, Kingdom of Saudi Arabia. Fax. +966 (17) 7253185. E-mail. dr.alqumber@gmail.com.
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Alqumber
mesh_terms: D036002:ADP Ribose Transferases / Q000235:genetics; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001426:Bacterial Proteins / Q000235:genetics; D001427:Bacterial Toxins / Q000235:genetics; D016360:Clostridioides difficile / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D003430:Cross-Sectional Studies; D004269:DNA, Bacterial / Q000032:analysis*; D024881:Drug Resistance, Bacterial; D004768:Enterotoxins / Q000235:genetics; D004866:Equipment Contamination / Q000706:statistics & numerical data*; D050456:Fomites / Q000382:microbiology*; D005511:Food Handling; D064704:Levofloxacin / Q000494:pharmacology; D008795:Metronidazole / Q000494:pharmacology; D008826:Microbial Sensitivity Tests; D016133:Polymerase Chain Reaction; D015995:Prevalence; D012329:RNA, Bacterial / Q000032:analysis*; D012097:Repressor Proteins / Q000235:genetics; D021521:Ribotyping; D012529:Saudi Arabia; D014640:Vancomycin / Q000494:pharmacology
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001427:Bacterial Toxins; D004269:DNA, Bacterial; D004768:Enterotoxins; D012329:RNA, Bacterial; D012097:Repressor Proteins; C105615:TcdC protein, Clostridium difficile; C041348:tcdA protein, Clostridium difficile; C031815:toxB protein, Clostridium difficile; D008795:Metronidazole; D064704:Levofloxacin; D014640:Vancomycin; D036002:ADP Ribose Transferases; C410164:actin-specific ADP-ribosyltransferase, Clostridium