Some Factors Influencing the Number of Clostridioides difficile Spores Detected in Hospital Wastewater

Abstract

Chun-Wei Chiu,1 Shiang-En Chen,2 Yu-Ting Lin,2 Ching-Chi Lee,3– 5 Jen-Chieh Lee,4,5 Chin-Shiang Tsai,4– 6 Wen-Chien Ko,4,5 Chih-Hsuan Tsai,2,5,&ast; Yuan-Pin Hung1,2,4,5,&ast; 1Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan; 2Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 3Clinical Medicine Research Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 4Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 5Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 6Department of Internal Medicine, National Cheng Kung University Hospital, Dou-Liou Branch, College of Medicine, National Cheng Kung University, Yunlin, Taiwan&ast;These authors contributed equally to this workCorrespondence: Chih-Hsuan Tsai, Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University, Medical College, No. 1, University Road, Tainan, 70101, Taiwan, Tel [phone] ext 5626, Email [email protected] Yuan-Pin Hung, Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, No. 125, Jhongshan Road, West Central Dist, Tainan, Taiwan, Tel [phone] ext. 6215, Email [email protected]: Clostridioides difficile is the most common cause of antibiotic-associated diarrhea. Wastewater from hospitals may be an important source of C. difficile transmission between hospitals and communities. The objective of this study is to quantify C. difficile spores and to elucidate their potential transmission risk via hospital wastewater.Methods: A prospective study of wastewater from a teaching hospital was conducted weekly, from July 2023 to June 2024. The number of C. difficile spores detected in wastewater from hospital settings fluctuated weekly during the study period.Results: There was a borderline association between the number of C. difficile spores detected in wastewater at room temperature in hospitals (p = 0.02) and the consumption of antimicrobial agents (p value = 0.04), particularly cephalosporins (p = 0.001). Specifically, the number of C. difficile spores detected in the wastewater was highly correlated with first-generation cephalosporin consumption (p = 0.002), particularly the consumption of first-generation intravenous cephalosporin (cefazolin) (p < 0.001).Conclusion: The number of C. difficile spores detected in wastewater from hospital settings is strongly associated with the consumption of antimicrobial agents, particularly cephalosporins. Further evaluation is needed to assess whether antibiotic stewardship programs can reduce the burden of C. difficile spores in wastewater.Plain Language Summary: Consumption of antimicrobial agents influences Clostridioides difficile spores in hospital wastewater.Keywords: Clostridioides difficile, spore, wastewater, cephalosporins, cefazolin, hospital setting

Keywords

• Clostridioides difficile
• spore
• wastewater
• cephalosporins
• cefazolin
• hospital setting