title: Environmental Contamination in Households of Patients with Recurrent Clostridium difficile Infection.
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.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Minnesota, Minneapolis, Minnesota, USA megan.shaughnessy@hcmed.org johns007@umn.edu.
authors.forename: Megan K
authors.initials: MK
authors.lastname: Shaughnessy
authors.affiliation: BioTechnology Institute, University of Minnesota, St. Paul, Minnesota, USA.
authors.forename: Aleh
authors.initials: A
authors.lastname: Bobr
authors.affiliation: Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA.|Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kuskowski
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Minnesota, Minneapolis, Minnesota, USA.|Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota, USA.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Johnston
authors.affiliation: BioTechnology Institute, University of Minnesota, St. Paul, Minnesota, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Sadowsky
authors.affiliation: Department of Medicine, Division of Gastroenterology, University of Minnesota, Minneapolis, Minnesota, USA.|BioTechnology Institute, University of Minnesota, St. Paul, Minnesota, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Khoruts
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Minnesota, Minneapolis, Minnesota, USA megan.shaughnessy@hcmed.org johns007@umn.edu.|Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D016360:Clostridioides difficile / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology*; D003430:Cross-Sectional Studies; D004783:Environmental Microbiology; D004787:Environmental Pollution / Q000706:statistics & numerical data*; D005191:Family Characteristics; D000069467:Fecal Microbiota Transplantation; D005243:Feces / Q000382:microbiology; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D057805:Pets / Q000382:microbiology; D015995:Prevalence; D012008:Recurrence; D055815:Young Adult