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Genomic survey of Clostridium difficile reservoirs in the East of England implicates environmental contamination of wastewater treatment plants by clinical lineages.

Authors
  • Moradigaravand, Danesh
  • Gouliouris, Theodore
  • Ludden, Catherine
  • Reuter, Sandra
  • Jamrozy, Dorota
  • Blane, Beth
  • Naydenova, Plamena
  • Judge, Kim
  • H Aliyu, Sani
  • F Hadjirin, Nazreen
  • A Holmes, Mark
  • Török, Estée
  • M Brown, Nicholas
  • Parkhill, Julian
  • Peacock, Sharon
Publication Date
Mar 02, 2018
Source
Apollo - University of Cambridge Repository
Keywords
Language
English
License
Green
External links

Abstract

There is growing evidence that patients with C. difficile-associated diarrhoea often acquire their infecting strain before hospital admission. Wastewater is known to be a potential source of surface water that is contaminated with C. difficile spores. Here, we describe a study that used genome sequencing to compare C. difficile isolated from multiple wastewater treatment plants across the East of England and from patients with clinical disease at a major hospital in the same region. We confirmed that C. difficile from 65 patients were highly diverse and that most cases were unlinked to other active cases in the hospital. 186 C. difficile isolates were isolated from effluent water obtained from 18 municipal treatment plants at the point of release into the environment. Whole genome comparisons of clinical and environmental isolates demonstrated highly related populations, and confirmed extensive release of toxigenic C. difficile into surface waters. An analysis based on multilocus sequence types (STs) identified 19 distinct STs in the clinical collection and 38 STs in the wastewater collection, with 13 of 44 STs common to both clinical and wastewater collections. Furthermore, we identified 5 pairs of highly similar isolates (=< 2 single nucleotide polymorphisms different in the core genome) in clinical and wastewater collections. Strategies to control community acquisition should consider the need for bacterial control of treated wastewater.

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