Playground Sandboxes Susceptible to C. difficile Transmission

The role in this risk may be exacerbated by access of pets and other animals.

Sandboxes at playgrounds are ripe with infections and parasites, and demonstrable levels of Clostridium difficile (C. difficile), according to a new report.

Researchers from Spain and the Netherlands examined 40 recreational sandboxes in order to evaluate the presence of C. difficile in them, which has only been explored a limited number of times. The 20 sandbox pairs were for children and dogs in areas around Madrid, Spain. The investigators then compared the isolates recovered from both the children’s and the dogs’ sandboxes samples (200g sand sample) between in July 2015 to test their genetic characteristics and in vitro antimicrobial susceptibility.

C. difficile was found in 21, or 52.5% of sand samples. 9 of the children’s sandboxes had C. difficile present, while the bacteria were found in 12 dogs’ sandboxes, the researchers reported.

Not only was C. difficile present in these samples, but the C. difficile strains were genetically diverse. Despite their origins, all isolates showed resistance to imipenem and levofloxacin, the researchers noted. Some isolates were resistant to clindamycin, erythromycin, and penicillin.

Because of C. difficile’s diversity and resistance to a wide variety of infection combatants, this issue poses what the researchers termed a major health risk. The study authors said that monitoring the resistance of C. difficile to these compounds should be a priority.

“Our results are just a call to action,” the study’s corresponding author, José Blanco, said. “A ‘One Health’ approach is required in future environmental surveys for this emerging pathogen.”

Prior studies have shown that playground soil is ripe with parasites and infection agents. A similar study conducted in Cardiff, United Kingdom in the 1990s showed that 21% of soil samples contained C. difficile. In France, a 2003 study determined 4% of soil collected from public parks, playgrounds, gardens, and cultivated fields contained C. difficile, but the paper did not detail origin or other such characteristics of the samples.

In another study done in the midwestern United States, an overall C. difficile presence of 6.5% was reported. However, that study, conducted in 2011 on public parks and elementary school playgrounds, did not account for genotype variance or antimicrobial resistance.

Children who use these facilities are most at risk due to high prevalence of geophagia (such as the consumption of sand), as well as their underdeveloped or immature immunological, neurological, and digestive systems.

“Our results revealed the presence of epidemic ribotypes of C. difficile in children’s and dogs’ sandboxes,” the study authors noted.

They added that the possible presence of this emerging pathogen "should be considered in any environmental risk assessment.”

The study, “Recreational sandboxes for children and dogs can be a source of epidemic ribotypes of Clostridium difficile,” was published online in the journal Zoonoses and Public Health.

A press release regarding the study was made available.

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