Environmental contamination in households of patients with recurrent clostridium difficile infection

Abstract

Background: Recurrent Clostridium difficile infection (R-CDI) is common and difficult to treat, potentially necessitating fecal microbiota transplantation (FMT). Although C. difficile spores can persist in the hospital environment and cause infection, little is known about their potential presence in the household environment.Methods: Households of R-CDI subjects in the peri-FMT period, and of geographically and age-matched controls, were analyzed for presence of C. difficile. Household environmental surfaces and fecal samples from humans and pets in the household were examined. Post-FMT subject households were also examined (environmental surfaces only). Participants were surveyed regarding their personal history and household cleaning habits. Environmental and fecal samples were cultured for C. difficile. Species identity and molecular characteristics of presumptive C. difficile isolates were determined using the PRO kit (Remel, USA), Gram staining, PCR, toxinotyping, tcdC gene sequencing, and pulsed-field gel electrophoresis (PFGE).Results: Environmental cultures detected C. difficile on ¡Ý 1 surface in 8/8 (100%) peri-FMT households vs. 3/8 (38%) post-FMT households and 3/8 (38%) control households (P = 0.025). The most common C. difficile-positive surfaces 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 (2 R-CDI subjects, 1 household member). Nine (90%) of 10 households with multiple C. difficile-positive samples had a single genotype present each. Conclusions: C. difficile was found in the household environment of R-CDI patients. Whether this is a cause or consequence of R-CDI is unknown. If household contamination leads to R-CDI, effective decontamination may be protective.