Cargando…

High levels of toxigenic Clostridioides difficile contamination of hospital environments: a hidden threat in hospital-acquired infections in Kenya

INTRODUCTION: The contribution of Clostridioides difficile (formerly Clostridium difficile ) to the burden of hospital-associated infections (HAIs) remains undetermined in many African countries. AIM: This study aimed to identify a sensitive and readily adaptable C. difficile detection assay and to...

Descripción completa

Detalles Bibliográficos
Autores principales: Odoyo, Erick, Kyanya, Cecilia, Mutai, Winnie, Musila, Lillian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Microbiology Society 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7818243/
https://www.ncbi.nlm.nih.gov/pubmed/33490867
http://dx.doi.org/10.1099/acmi.0.000171
_version_ 1783638794408296448
author Odoyo, Erick
Kyanya, Cecilia
Mutai, Winnie
Musila, Lillian
author_facet Odoyo, Erick
Kyanya, Cecilia
Mutai, Winnie
Musila, Lillian
author_sort Odoyo, Erick
collection PubMed
description INTRODUCTION: The contribution of Clostridioides difficile (formerly Clostridium difficile ) to the burden of hospital-associated infections (HAIs) remains undetermined in many African countries. AIM: This study aimed to identify a sensitive and readily adaptable C. difficile detection assay and to evaluate the C. difficile HAI risk in Kenya. METHODOLOGY: Sterile swabs in neutralizing buffer were used to sample equipment or surfaces that patients and clinical staff touched frequently. These swabs were either plated directly on chromogenic agar or cultured in an enrichment broth before plating. The swab suspensions, enrichment broth and plate cultures were screened by quantitative PCR (qPCR) to determine the most efficient detection method. The HAI risk was evaluated by testing the C. difficile -positive samples by qPCR for the A, B and binary toxins. RESULTS: C. difficile was detected on 4/57 (7.0 %) equipment and surfaces by direct culture. The additional enrichment step increased the detection rate 10-fold to 43/57 (75.4 %). In total, 51/57 (89.5 %) environmental samples were positive for C. difficile detected through either culture or qPCR. The genes encoding the primary toxins, tcdA and tcdB, were detected on six surfaces, while the genes encoding the binary toxins, cdtA and cdtB, were detected on 2/57 (3.5 %) and 3/57 (5.3 %) surfaces, respectively. Different C. difficile toxin gene profiles were detected: the tcdA+/tcdB− gene profile on 4/10 (40 %) high-touch surfaces, tcdA−/tcdB+ on 3/10 (30 %) surfaces, tcdA+/tcdB+/cdtA+/cdtB+ on 2/10 (20 %) surfaces and tcdA−/tcdB+/cdtB+ on one high-touch surface. CONCLUSION: The widespread contamination of hospital environments by toxigenic C. difficile gives a strong indication of the high risk of C. difficile infections (CDIs). The two-step culture process described can easily be adapted for monitoring hospital environment contamination by C. difficile .
format Online
Article
Text
id pubmed-7818243
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Microbiology Society
record_format MEDLINE/PubMed
spelling pubmed-78182432021-01-21 High levels of toxigenic Clostridioides difficile contamination of hospital environments: a hidden threat in hospital-acquired infections in Kenya Odoyo, Erick Kyanya, Cecilia Mutai, Winnie Musila, Lillian Access Microbiol Research Article INTRODUCTION: The contribution of Clostridioides difficile (formerly Clostridium difficile ) to the burden of hospital-associated infections (HAIs) remains undetermined in many African countries. AIM: This study aimed to identify a sensitive and readily adaptable C. difficile detection assay and to evaluate the C. difficile HAI risk in Kenya. METHODOLOGY: Sterile swabs in neutralizing buffer were used to sample equipment or surfaces that patients and clinical staff touched frequently. These swabs were either plated directly on chromogenic agar or cultured in an enrichment broth before plating. The swab suspensions, enrichment broth and plate cultures were screened by quantitative PCR (qPCR) to determine the most efficient detection method. The HAI risk was evaluated by testing the C. difficile -positive samples by qPCR for the A, B and binary toxins. RESULTS: C. difficile was detected on 4/57 (7.0 %) equipment and surfaces by direct culture. The additional enrichment step increased the detection rate 10-fold to 43/57 (75.4 %). In total, 51/57 (89.5 %) environmental samples were positive for C. difficile detected through either culture or qPCR. The genes encoding the primary toxins, tcdA and tcdB, were detected on six surfaces, while the genes encoding the binary toxins, cdtA and cdtB, were detected on 2/57 (3.5 %) and 3/57 (5.3 %) surfaces, respectively. Different C. difficile toxin gene profiles were detected: the tcdA+/tcdB− gene profile on 4/10 (40 %) high-touch surfaces, tcdA−/tcdB+ on 3/10 (30 %) surfaces, tcdA+/tcdB+/cdtA+/cdtB+ on 2/10 (20 %) surfaces and tcdA−/tcdB+/cdtB+ on one high-touch surface. CONCLUSION: The widespread contamination of hospital environments by toxigenic C. difficile gives a strong indication of the high risk of C. difficile infections (CDIs). The two-step culture process described can easily be adapted for monitoring hospital environment contamination by C. difficile . Microbiology Society 2020-09-18 /pmc/articles/PMC7818243/ /pubmed/33490867 http://dx.doi.org/10.1099/acmi.0.000171 Text en © 2020 The Authors http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License.
spellingShingle Research Article
Odoyo, Erick
Kyanya, Cecilia
Mutai, Winnie
Musila, Lillian
High levels of toxigenic Clostridioides difficile contamination of hospital environments: a hidden threat in hospital-acquired infections in Kenya
title High levels of toxigenic Clostridioides difficile contamination of hospital environments: a hidden threat in hospital-acquired infections in Kenya
title_full High levels of toxigenic Clostridioides difficile contamination of hospital environments: a hidden threat in hospital-acquired infections in Kenya
title_fullStr High levels of toxigenic Clostridioides difficile contamination of hospital environments: a hidden threat in hospital-acquired infections in Kenya
title_full_unstemmed High levels of toxigenic Clostridioides difficile contamination of hospital environments: a hidden threat in hospital-acquired infections in Kenya
title_short High levels of toxigenic Clostridioides difficile contamination of hospital environments: a hidden threat in hospital-acquired infections in Kenya
title_sort high levels of toxigenic clostridioides difficile contamination of hospital environments: a hidden threat in hospital-acquired infections in kenya
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7818243/
https://www.ncbi.nlm.nih.gov/pubmed/33490867
http://dx.doi.org/10.1099/acmi.0.000171
work_keys_str_mv AT odoyoerick highlevelsoftoxigenicclostridioidesdifficilecontaminationofhospitalenvironmentsahiddenthreatinhospitalacquiredinfectionsinkenya
AT kyanyacecilia highlevelsoftoxigenicclostridioidesdifficilecontaminationofhospitalenvironmentsahiddenthreatinhospitalacquiredinfectionsinkenya
AT mutaiwinnie highlevelsoftoxigenicclostridioidesdifficilecontaminationofhospitalenvironmentsahiddenthreatinhospitalacquiredinfectionsinkenya
AT musilalillian highlevelsoftoxigenicclostridioidesdifficilecontaminationofhospitalenvironmentsahiddenthreatinhospitalacquiredinfectionsinkenya