Whole-genome sequencing links Clostridium (Clostridioides) difficile in a single hospital to diverse environmental sources in the community

Su Chen Lim, Deirdre A. Collins, Korakrit Imwattana, Daniel R. Knight, Sicilia Perumalsamy, Natasza M.R. Hain-Saunders, Papanin Putsathit, David Speers, Thomas V. Riley

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)


Aims: To investigate if Clostridium (Clostridioides) difficile infection (CDI), traditionally thought of as hospital-acquired, can be genomically linked to hospital or community environmental sources, and to define possible importation routes from the community to the hospital. Methods and Results: In 2019, C. difficile was isolated from 89/300 (29.7%) floor and 96/300 (32.0%) shoe sole samples at a tertiary hospital in Western Australia. Non-toxigenic C. difficile ribotype (RT) 010 predominated among floor (96.6%) and shoe sole (73.2%) isolates, while toxigenic RT 014/020 was most prevalent among contemporaneous clinical cases (33.0%) at the hospital. Whole-genome sequencing and high-resolution core genome single nucleotide polymorphism (cgSNP) analysis on C. difficile strains from hospital and community sources showed no clinical C. difficile RT 014/020 strains were genetically related, and evidence of frequent long-distance, multi-directional spread between humans, animals and the environment. In addition, cgSNP analysis of environmental RT 010 strains suggested transportation of C. difficile via shoe soles. Conclusions: While C. difficile RT 014/020 appears to spread via routes outside the healthcare system, RT 010 displayed a pattern of possible importation from the community into the hospital. Significance and Impact of Study: These findings suggest developing community-based infection prevention and control strategies could significantly lower rates of CDI in the hospital setting.

Original languageEnglish
Pages (from-to)1156-1168
Number of pages13
JournalJournal of Applied Microbiology
Issue number3
Early online date11 Dec 2021
Publication statusPublished - Sept 2022


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