Environmental contamination with Clostridioides (Clostridium) difficile in Vietnam

Aims: To investigate the prevalence, molecular type and antimicrobial susceptibility of C. difficile in the environment in Vietnam, where little is known about C. difficile.

Methods and results: Samples of pig faeces, soils from pig farms, potatoes and the hospital environment were cultured for C. difficile. Isolates were identified and typed by PCR ribotyping. The overall prevalence of C. difficile contamination was 24.5% (68/278). C. difficile was detected mainly in soils from pig farms and hospital soils, with 70% to 100% prevalence. C. difficile was isolated from 3.4% of pig faecal samples and 5% of potato surfaces. The four most prevalent ribotypes (RTs) were RTs 001, 009, 038 and QX574. All isolates were susceptible to metronidazole, fidaxomicin, vancomycin and amoxicillin/clavulanate while resistance to erythromycin, tetracycline and moxifloxacin was common in toxigenic strains. C. difficile RTs 001A⁺B⁺CDT^- and 038A^-B^-CDT^- were predominantly multidrug-resistant.

Conclusions: Environmental sources of C. difficile are important to consider in the epidemiology of CDI in Vietnam, however, contaminated soils are likely to be the most important source of C. difficile. This poses additional challenges to controlling infections in healthcare settings.