Advertisement

Matching Clostridioides difficile strains obtained from shoe soles of healthcare workers epidemiologically linked to patients and confirmed by whole-genome sequencing

  • A.C. Büchler
    Affiliations
    Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
    Search for articles by this author
  • M. Wicki
    Affiliations
    Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
    Search for articles by this author
  • R. Frei
    Affiliations
    Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
    Search for articles by this author
  • V. Hinic
    Affiliations
    Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland

    Clinical Bacteriology and Mycology, University Hospital Basel, University of Basel, Basel, Switzerland
    Search for articles by this author
  • H.M.B. Seth-Smith
    Affiliations
    Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland

    Clinical Bacteriology and Mycology, University Hospital Basel, University of Basel, Basel, Switzerland
    Search for articles by this author
  • A. Egli
    Affiliations
    Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland

    Clinical Bacteriology and Mycology, University Hospital Basel, University of Basel, Basel, Switzerland
    Search for articles by this author
  • A.F. Widmer
    Correspondence
    Corresponding author. Address: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Petersgraben 4, 4031 Basel, Switzerland.
    Affiliations
    Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
    Search for articles by this author

      Summary

      Background

      The source of transmission of Clostridioides difficile in healthcare institutions is frequently unknown. The aim of this prospective cohort study was to assess the association between strains cultured from patients and shoe soles of healthcare workers (HCWs), as already shown in the operating theatre, but not on general hospital wards in an acute-care institution.

      Methods

      We conducted a study at a university tertiary care centre in Switzerland. From October 2019 to July 2020, shoe soles of HCWs were cultured for C. difficile twice per shift while taking care of a patient infected with toxigenic C. difficile. Additional risk factors were assessed by interviewing involved HCWs. Patients' faecal samples were processed by routine microbiological methods. Similarity of the HCWs' and patients' strains was determined by whole-genome sequencing (WGS).

      Results

      A total of 103 HCWs exposed to 42 hospitalized patients participated in the study, providing 206 samples. Contamination of shoe soles with C. difficile was detected in 37 samples (17.8%) of HCWs taking care of patients infected with C. difficile. Overall, transmission was suspected by epidemiological link and matching strains demonstrated by WGS in 74%.

      Conclusions

      HCWs' shoe soles were positive in 17.8% with C. difficile strains linked epidemiologically and confirmed by WGS to infected patients suggesting potential transmission by HCWs' shoe soles. This pilot study provides sufficient evidence to further evaluate this potential mode of healthcare-associated transmission of C. difficile by a larger clinical trial.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Hospital Infection
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Sethi A.K.
        • Al-Nassir W.N.
        • Nerandzic M.M.
        • Bobulsky G.S.
        • Donskey C.J.
        Persistence of skin contamination and environmental shedding of Clostridium difficile during and after treatment of C. difficile infection.
        Infect Control Hosp Epidemiol. 2010; 31: 21-27
        • Landelle C.
        • Verachten M.
        • Legrand P.
        • Girou E.
        • Barbut F.
        • Buisson C.B.
        Contamination of healthcare workers’ hands with Clostridium difficile spores after caring for patients with C. difficile infection.
        Infect Control Hosp Epidemiol. 2014; 35: 10-15
        • Rashid T.
        • VonVille H.M.
        • Hasan I.
        • Garey K.W.
        Shoe soles as a potential vector for pathogen transmission: a systematic review.
        J Appl Microbiol. 2016; 121: 1223-1231
        • Lim S.-C.
        • Collins D.A.
        • Imwattana K.
        • Knight D.R.
        • Perumalsamy S.
        • Hain-Saunders N.M.R.
        • et al.
        Whole-genome sequencing links Clostridium (Clostridioides) difficile in a single hospital t o diverse environmental sources in the community.
        J Appl Microbiol. 2021; (00): 1-13
        • Mangram A.J.
        • Horan T.C.
        • Pearson M.L.
        • Silver L.C.
        • Jarvis W.R.
        Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee.
        Am J Infect Control. 1999; 27: 97-134
        • Amirfeyz R.
        • Tasker A.
        • Ali S.
        • Bowker K.
        • Blom A.
        Theatre shoes — a link in the common pathway of postoperative wound infection?.
        Ann R Coll Surg Engl. 2007; 89: 605-608
        • Kanwar A.
        • Thakur M.
        • Wazzan M.
        • Satyavada S.
        • Cadnum J.L.
        • Jencson A.L.
        • et al.
        Clothing and shoes of personnel as potential vectors for transfer of health care-associated pathogens to the community.
        Am J Infect Control. 2019; 47: 577-579
        • Janezic S.
        • Mlakar S.
        • Rupnik M.
        Dissemination of Clostridium difficile spores between environment and households: dog paws and shoes.
        Zoonoses Public Health. 2018; 65: 669-674
        • Redmond S.N.
        • Pearlmutter B.S.
        • Ng-Wong Y.K.
        • Alhmidi H.
        • Cadnum J.L.
        • Silva S.Y.
        • et al.
        Timing and route of contamination of hospitalized patient rooms with healthcare-associated pathogens.
        Infect Control Hosp Epidemiol. 2021; 42: 1076-1081
        • Deshpande A.
        • Cadnum J.L.
        • Fertelli D.
        • Sitzlar B.
        • Thota P.
        • Mana T.S.
        • et al.
        Are hospital floors an underappreciated reservoir for transmission of health care-associated pathogens?.
        Am J Infect Control. 2017; 45: 336-338
        • Davies K.
        • Mawer D.
        • Sarah Walker A.
        • Berry C.
        • Planche T.
        • Stanley P.
        • et al.
        An analysis of Clostridium difficile environmental contamination during and after treatment for C. difficile infection.
        Open Forum Infect Dis. 2020; 7: 1-9
        • Balsells E.
        • Shi T.
        • Leese C.
        • Lyell I.
        • Burrows J.
        • Wiuff C.
        • et al.
        Global burden of Clostridium difficile infections: a systematic review and meta-analysis.
        J Glob Health. 2019; 9010407
        • Furuya-Kanamori L.
        • Stone J.C.
        • Clark J.
        • McKenzie S.J.
        • Yakob L.
        • Paterson D.L.
        • et al.
        Comorbidities, exposure to medications, and the risk of community-acquired Clostridium difficile infection: a systematic review and meta-analysis.
        Infect Control Hosp Epidemiol. 2015; 36: 132-141
        • Rashid T.
        • Poblete K.
        • Amadio J.
        • Hasan I.
        • Begum K.
        • Alam M.J.
        • et al.
        Evaluation of a shoe sole UVC device to reduce pathogen colonization on floors, surfaces and patients.
        J Hosp Infect. 2018; 98: 96-101
        • Widmer A.F.
        • Frei R.
        • Erb S.
        • Stranden A.
        • Kuijper E.J.
        • Knetsch C.W.
        • et al.
        Transmissibility of Clostridium difficile without contact isolation: results from a prospective observational study with 451 patients.
        Clin Infect Dis. 2017; 64: 393-400
        • Seth-Smith H.M.B.
        • Biggel M.
        • Roloff T.
        • Hinic V.
        • Bodmer T.
        • Risch M.
        • et al.
        Transition From PCR-ribotyping to whole genome sequencing based typing of Clostridioides difficile.
        Front Cell Infect Microbiol. 2021; 11: 1-10
        • Wick R.R.
        • Judd L.M.
        • Gorrie C.L.
        • Holt K.E.
        Unicycler: resolving bacterial genome assemblies from short and long sequencing reads.
        PLoS Comput Biol. 2017; 13: 1-22
        • Jünemann S.
        • Sedlazeck F.J.
        • Prior K.
        • Albersmeier A.
        • John U.
        • Kalinowski J.
        • et al.
        Updating benchtop sequencing performance comparison.
        Nat Biotechnol. 2013; 31: 294-296
        • Bletz S.
        • Janezic S.
        • Harmsen D.
        • Rupnik M.
        • Mellmann A.
        Defining and evaluating a core genome multilocus sequence typing scheme for genome-wide typing of Clostridium difficile.
        J Clin Microbiol. 2018; 56 (e01987-17)
        • Tyrrell K.L.
        • Citron D.M.
        • Leoncio E.S.
        • Merriam C.V.
        • Goldstein E.J.C.
        Evaluation of cycloserine-cefoxitin fructose agar (CCFA), CCFA with horse blood and taurocholate, and cycloserine-cefoxitin mannitol broth with taurocholate and lysozyme for recovery of Clostridium difficile isolates from fecal samples.
        J Clin Microbiol. 2013; 51: 3094-3096
        • Galvin J.
        • Almatroudi A.
        • Vickery K.
        • Deva A.
        • Lopes L.K.O.
        • Costa D. de M.
        • et al.
        Patient shoe covers: transferring bacteria from the floor onto surgical bedsheets.
        Am J Infect Control. 2016; 44: 1417-1419