Clostridioides difficile Isolated from Water; Prevalence, Antibiotic Susceptibility and Toxigenic Activity.

Objective: Evaluate the prevalence, antibiotic susceptibility and toxigenic activity of Clostridioides difficile (C. difficile) detected in water samples collected from Mansoura city, Egypt. Methods: A total of 200 water samples were collected. Standard microbiological methods including enrichment/selective cultures were used for isolation and identification of C. difficile. Epsilon tests were used to detect resistance/susceptibility of the iso- lates to clindamycin, metronidazole and vancomycin antibiotics. Xpect CD Toxin A/B test was used to detect their toxigenicity. Results: Prevalence of C. difficile isolates was 19.0% (38 isolates / 200 collected samples) and the majority (78.9%) of them were toxigenic. Distribution of isolates was as follows; 17 from water supply intake pipe (13 of them were toxigenic), 13 from waste water treatment (12 of them were toxigenic), 5 from house tap water (two of them were toxigenic) and three from public swimming pool (all of them were toxigenic). Variable degrees of resistance to clindamycin and metronidazole were detected. All isolates were sensitive to vancomycin. Conclusion: The study has illustrated that C. difficile is widespread in water sources including the municipal water supply from domestic housing and swimming pool water samples. Water can be a source for antibiotic resistant toxin producing C. difficile transmission. [ABSTRACT FROM AUTHOR]