Biocide Resistance and Transmission of Clostridium difficile Spores Spiked onto Clinical Surfaces from an American Health Care Facility
Biocide Resistance and Transmission of Clostridium difficile Spores Spiked onto Clinical Surfaces from an American Health Care Facility
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DOI：
10.1128/aem.01090-19
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发表时间：
2019-09-01
影响因子：
4.4
通讯作者：
Joshi, Lovleen Tina
中科院分区：
文献类型：
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作者：
Dyer, Calie;Hutt, Lee P.;Joshi, Lovleen Tina
艰难梭菌是全球抗生素相关性腹泻的主要原因。在不利的环境中，这种有机体产生高度抗性的孢子，可以在杀菌剂的侮辱下生存下来。我们之前的研究测定了艰难梭菌孢子附着在临床表面的能力，发现孢子具有明显不同的疏水性和附着能力。对杀菌剂二氯异氰尿酸钠对艰难梭菌孢子传播的影响的研究表明，亚致死浓度增加了孢子的粘附力，而不会降低活力。本研究检测了孢子在临床表面传播的能力，以及它们对正在使用的1000ppm氯释放剂二氯异氰尿酸钠消毒浓度的反应。为了了解这些表面是否有助于医院内的孢子传播，在外科隔离服、医院级不锈钢和地板胶中添加了两种艰难梭菌孢子制剂：粗孢子和纯化孢子，每毫升添加1×10(6)个孢子。用平板转移法和扫描电子显微镜检测不同孢子类型对临床表面的疏水性。重复实验，在推荐的10分钟接触时间下，将尖端的临床表面暴露在1000ppm的二氯异氰尿酸钠中。结果表明，临床面的疏水性和结构可以影响孢子的传播，而外表面结构可能在孢子黏附中起一定作用。在建议的消毒浓度下接触杀菌剂后，临床表面上的孢子仍然活着，显示出无效的杀孢子作用。这项研究表明，艰难梭菌的孢子可以在适当使用杀菌剂的情况下在不同的临床表面之间传播和存活。艰难梭菌是一种保健获得性微生物，也是抗生素相关性腹泻的病原体。由于其粘附性，它的孢子与从卫生保健环境中受污染的表面的粪便到口腔的传播有关。使用高强度化学品清洁受污染的表面，以去除和杀死孢子；然而，尽管采取了适当的感染控制措施，艰难梭菌感染在美国患者中的发病率仍然很高。我们的研究检查了一种高强度杀生剂对艰难梭菌孢子的影响，艰难梭菌已经被添加到一系列临床相关的表面上，包括隔离服、不锈钢和地板乙烯基。这项研究发现艰难梭菌孢子能够在适当浓度的杀生剂中存活，这突出表明需要检查感染控制措施的有效性，以防止孢子传播，并在净化卫生保健表面时考虑杀生剂耐药性的流行情况。
Clostridium difficile is the primary cause of antibiotic-associated diarrhea globally. In unfavorable environments, the organism produces highly resistant spores which can survive microbicidal insult. Our previous research determined the ability of C. difficile spores to adhere to clinical surfaces, finding that spores had markedly different hydrophobic properties and adherence abilities. Investigation into the effect of the microbicide sodium dichloroisocyanurate on C. difficile spore transmission revealed that sublethal concentrations increased spore adherence without reducing viability. The present study examined the ability of spores to transmit across clinical surfaces and their response to an in-use disinfection concentration of 1,000 ppm of chlorine-releasing agent sodium dichloroisocyanurate. In an effort to understand if these surfaces contribute to nosocomial spore transmission, surgical isolation gowns, hospital-grade stainless steel, and floor vinyl were spiked with 1 x 10(6) spores/ml of two types of C. difficile spore preparations: crude spores and purified spores. The hydrophobicity of each spore type versus clinical surface was examined via plate transfer assay and scanning electron microscopy. The experiment was repeated, and spiked clinical surfaces were exposed to 1,000 ppm sodium dichloroisocyanurate at the recommended 10-min contact time. Results revealed that the hydrophobicity and structure of clinical surfaces can influence spore transmission and that outer spore surface structures may play a part in spore adhesion. Spores remained viable on clinical surfaces after microbicide exposure at the recommended disinfection concentration, demonstrating ineffectual sporicidal action. This study showed that C. difficile spores can transmit and survive between various clinical surfaces despite appropriate use of microbicides.IMPORTANCE Clostridium difficile is a health care-acquired organism and the causative agent of antibiotic-associated diarrhea. Its spores are implicated in fecal to oral transmission from contaminated surfaces in the health care environment due to their adherent nature. Contaminated surfaces are cleaned using high-strength chemicals to remove and kill the spores; however, despite appropriate infection control measures, there is still high incidence of C. difficile infection in patients in the United States. Our research examined the effect of a high-strength biocide on spores of C. difficile which had been spiked onto a range of clinically relevant surfaces, including isolation gowns, stainless steel, and floor vinyl. This study found that C. difficile spores were able to survive exposure to appropriate concentrations of biocide, highlighting the need to examine the effectiveness of infection control measures to prevent spore transmission and to consider the prevalence of biocide resistance when decontaminating health care surfaces.