Clostridioides difficile
• Clostridioides difficile is a gram-positive anaerobe and the most common cause of hospital-acquired antimicrobial diarrhoea in people. Clostridioides difficile infection (CDI) is related to toxin production, not the mere isolation of the organism in culture or by molecular testing. Different strains are identified that vary in virulence due to differential production of toxins. • Clostridioides difficile has been isolated from healthy dogs and cats, and those with diarrhoea. Globally, carriage of C. difficile in healthy adult dogs has been reported to be between 0-6%. 31 Carriage rates in healthy cats are thought to be similar to dogs. 31,32 • Higher rates of carriage are reported in dogs that visit human hospitals, have contact with children, or reside with immunocompromised owners. Recent hospitalisation or out- patient veterinary care, and treatment with antimicrobials is also associated with increased carriage. 31
• The role of C. difficile in infectious canine and feline gastrointestinal disease is unclear.
• There is low prevalence of C. difficile in healthy humans (except neonates, where C. difficile carriage is not uncommon), with increased risk of carriage of toxin positive strains and secondary C. difficile colitis associated with prolonged hospitalisation and prior antimicrobial therapy. • Disease in humans may range from mild to fulminant and potentially fatal pseudomembranous colitis or toxic megacolon. • Some strains are found in both humans and dogs suggesting interspecies transmission, however the direction of transmission is unclear (animal-to-human or vice versa).
ACAZAP RECOMMENDATIONS
• All diarrhoeic animals should be considered potential sources of transmission and appropriate infection control procedures implemented.
• The zoonotic potential of C. difficile is unclear, and infection in cohabitating companion animals and humans may represent zoonotic transmission or a
common source of exposure.
KEY CONSIDERATIONS 1. A One Health approach is essential in tackling the issue of AMR as bi-directional cross-species transmission of organisms/genes from animal-to-human or vice versa may occur. 2. Good hand hygiene practices following contact with animals, animal food or treats, food bowls, animal bedding and animal faeces can minimise the zoonotic transmission of AMR. Additional precautions should be taken, both
in the clinic and home environment, for animals with documented AMR infections. 3. The primary drivers of AMR are antimicrobial use and poor infection control practices. - Veterinarians should follow prudent use guidelines and avoid where possible the use of antimicrobials of high importance, such as fluroquinolones and third generation cephalosporins. - Clinics should have agreed and documented infection control practices that consider hand hygiene, environmental hygiene, and the appropriate use of PPE.
The primary drivers of AMR are antimicrobial use and poor infection control practices.
CONTENTS
Companion Animal Zoonoses Guidelines 13
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