Community Environmental Contamination of Toxigenic .

Background: infection is often considered to result from recent acquisition of a isolate in a healthcare setting. However, spores can persist for long periods of time, suggesting a potentially large community environmental reservoir. The objectives of this study were to assess community environmental contamination of toxigenic and to assess strain distribution in environmental versus clinical isolates.

Methods: From 2013 to 2015, we collected community environmental swabs from homes and public areas in Houston, Texas to assess contamination. All positive isolates were tested for toxins A and B, ribotyped, and compared with clinical isolates obtained from hospitalized patients in Houston healthcare settings.

Results: A total of 2538 environmental samples were collected over the study period. These included samples obtained from homes (n = 1079), parks (n = 491), chain stores (n = 225), fast food restaurants (n = 123), other commercial stores (n = 172), and hospitals (n = 448). Overall, 418 environmental isolates grew toxigenic (16.5%; < .001) most commonly from parks (24.6%), followed by homes (17.1%), hospitals (16.5%), commercial stores (8.1%), chain stores (7.6%), and fast food restaurants (6.5%). A similar distribution of ribotypes was observed between clinical and environmental isolates with the exception that ribotype 027 was more common in clinical isolates compared with environmental isolates ( < .001).

Conclusions: We identified a high prevalence of toxigenic from community environs that were similar ribotypes to clinical isolates. These findings suggest that interventions beyond isolation of symptomatic patients should be targeted for prevention of infection.