Isolation of Clostridioides difficile PCR Ribotype 027 from single-use hospital gown ties

Abstract

<jats:p> <jats:bold>Background.</jats:bold> <jats:italic> <jats:named-content content-type="species"> <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://doi.org/10.1601/nm.28959" xlink:type="simple">Clostridioides difficile</jats:ext-link> </jats:named-content> </jats:italic> is a spore-forming pathogen responsible for antibiotic-associated diarrhoea. In the USA high incidence of <jats:italic> <jats:named-content content-type="species"> <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://doi.org/10.1601/nm.28959" xlink:type="simple">C. difficile</jats:ext-link> </jats:named-content> </jats:italic> infection (CDI) in clinical environments has led to interest in <jats:italic> <jats:named-content content-type="species"> <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://doi.org/10.1601/nm.28959" xlink:type="simple">C. difficile</jats:ext-link> </jats:named-content> </jats:italic> spore transmission.</jats:p> <jats:p> <jats:bold>Hypothesis.</jats:bold> Single use hospital surgical gown ties act as a reservoir for <jats:italic> <jats:named-content content-type="species"> <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://doi.org/10.1601/nm.28959" xlink:type="simple">C. difficile</jats:ext-link> </jats:named-content> </jats:italic> spores.</jats:p> <jats:p> <jats:bold>Aim.</jats:bold> This study sought to examine whether single-use hospital surgical gown ties used in surgery, from an acute healthcare facility, harboured <jats:italic> <jats:named-content content-type="species"> <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://doi.org/10.1601/nm.28959" xlink:type="simple">C. difficile</jats:ext-link> </jats:named-content> </jats:italic> spores.</jats:p> <jats:p> <jats:bold>Methodology.</jats:bold> Used surgical gowns ties worn by clinicians in the healthcare facility were examined for <jats:italic> <jats:named-content content-type="species"> <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://doi.org/10.1601/nm.28959" xlink:type="simple">C. difficile</jats:ext-link> </jats:named-content> </jats:italic> spore presence via spread plate and anaerobic culture. The colonies isolated from each gown tie were subcultured on <jats:italic> <jats:named-content content-type="species"> <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://doi.org/10.1601/nm.28959" xlink:type="simple">C. difficile</jats:ext-link> </jats:named-content> </jats:italic> selective agar for phenotypic confirmation. Presumptive <jats:italic> <jats:named-content content-type="species"> <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://doi.org/10.1601/nm.28959" xlink:type="simple">C. difficile</jats:ext-link> </jats:named-content> </jats:italic> colonies were examined using <jats:italic> <jats:named-content content-type="species"> <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://doi.org/10.1601/nm.28959" xlink:type="simple">C. difficile</jats:ext-link> </jats:named-content> </jats:italic> Quik Check Complete, 16–23S PCR Ribotyping and MALDI-TOF analysis.</jats:p> <jats:p> <jats:bold>Results.</jats:bold> In total 17 suspected <jats:italic> <jats:named-content content-type="species"> <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://doi.org/10.1601/nm.28959" xlink:type="simple">C. difficile</jats:ext-link> </jats:named-content> </jats:italic> colonies were isolated from 15 gown ties via culture. <jats:italic> <jats:named-content content-type="species"> <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://doi.org/10.1601/nm.28959" xlink:type="simple">C. difficile</jats:ext-link> </jats:named-content> </jats:italic> Quik Check Complete found two isolates as possible <jats:italic> <jats:named-content content-type="species"> <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://doi.org/10.1601/nm.28959" xlink:type="simple">C. difficile</jats:ext-link> </jats:named-content> </jats:italic>. MALDI-TOF and PCR Ribotyping confirmed one isolate as <jats:italic> <jats:named-content content-type="species"> <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://doi.org/10.1601/nm.28959" xlink:type="simple">C. difficile</jats:ext-link> </jats:named-content> </jats:italic> PCR ribotype 027 associated with clinical outbreaks.</jats:p> <jats:p> <jats:bold>Discussion.</jats:bold> Our study revealed the presence of hypervirulent <jats:italic> <jats:named-content content-type="species"> <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://doi.org/10.1601/nm.28959" xlink:type="simple">C. difficile</jats:ext-link> </jats:named-content> </jats:italic> ribotype 027 spores on single-use gown ties. This highlights the potential of gown ties as a vector of spore transmission across clinical environments, especially when gowns are not worn appropriately.</jats:p> <jats:p> <jats:bold>Conclusions.</jats:bold> Appropriate compliance to infection control procedures by healthcare workers is essential to prevent spore dissemination across clinical facilities and reduce CDI rates.</jats:p>