Investigation of transmission of Clostridium difficile from contaminated community and hospital environments

Dr Deirdre Collins1, Dr Su Chen Lim1, Prof Thomas Riley1,2

1School of Medical & Health Sciences, Edith Cowan University, Joondalup, Australia, 2PathWest Laboratory Medicine WA, Nedlands, Australia

Introduction: The notion that transmission of Clostridium difficile infection (CDI) is primarily from patient to patient is questionable following genomic studies. This study aimed to investigate whether CDI cases were linked to contaminated community and hospital environments.

Methods: Whole genome sequences of C. difficile ribotype 014 strains cultured from outdoor community and hospital environments (n=43), staff/visitor shoe soles (n=20) and clinical cases of CDI in 2019 (n=28) were compared by single nucleotide variant (SNV) analysis.

Results: Strains from four clinical CDI cases (14.3%) matched (<2 SNV differences) environmental strains, implying transmission from the environment. One case strain was related to C. difficile from two shoe samples, as well as one from hospital grounds. Only two clinical case strains were related (implying patient to patient transmission), however, these cases occurred 4 months apart.

Conclusions: CDI was apparently more commonly transmitted from contaminated outdoor and hospital environments than from other CDI cases.


Dr Collins is an NHMRC Early Career Fellow working with Professor Thomas Riley’s Clostridium difficile research group, based in the R&D laboratories of PathWest Laboratory Medicine, QEII Medical Centre. She specialises in the epidemiology of Clostridium difficile infection and One Health aspects of its transmission.

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