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

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. 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. 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). 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.