In vitro Production of Clostridium difficile Spores for Use in the Efficacy Evaluation of Disinfectants: A Precollaborative Investigation
Authors: Hasan Jafrul A , Japal Knoxley M , Christensen Erick R , Samalot-Freire Luisa C 
Published: February 2020

Abstract
Clostridium difficile is a strict anaerobic spore-forming bacterium, and an increasingly common nosocomial pathogen. The U.S. Environmental Protection Agency (EPA) is responsible for the registration of disinfectants, including products designed to treat environmental surfaces contaminated with spores of C. difficile. Product efficacy data are required for registration; however, there is a lack of methodology for generating high-quality spore suspensions for evaluating product performance. As such, a study was carried out to select a suitable C. difficile strain and to develop a stand-alone method to prepare a spore suspension that meets specific criteria necessary for quantitative testing of disinfectants. The criteria are: (1) a spore titer of &gt;8 log10/mL, (2) ≥90% spores to vegetative cells, and (3) resistance of spores (determined by viability) to 2.5 M hydrochloric acid (HCl). Several strains of C. difficile (toxigenic and nontoxigenic) were grown on various media (solid and liquid) for varying lengths of time to determine the best combination of incubation conditions and media to optimize spore production and quality. Once the spore production procedure was optimized, a toxigenic strain of C. difficile [American Type Culture Collection (ATCC) 43598] was selected for use in trials to verify repeatability from one production run to the next. The spore suspension was initiated by spreading vegetative cells of C. difficile (ATCC 43598) on CDC anaerobic 5% sheep blood agar plates and incubating for 7–10 days at 36 ± 1 °C under anaerobic conditions. Spores were harvested when ≥90% of the cells converted to spores as determined by observation using phase-contrast microscopy. The spores were washed three times with saline–Tween-80, resuspended in cold deionized water, heated to 70°C for 10 min, evaluated microscopically for quality, and enumerated on cycloserine-cefoxitin-fructose agar containing horse blood and taurocholate. The spore suspension was used to inoculate brushed stainless steel carriers (1 cm in diameter) with and without a soil load in accordance with the Standard Quantitative Carrier Disk Test Method (ASTM E-2197-02) to determine carrier load. Once it was determined that &gt;6 log10 spores/carrier could be recovered, spores were evaluated for resistance to HCl. The sporulation method presented in this report is simple and repeatable and results in spore suspension of high titer (&gt;8 log10/mL) and quality (≥90% spores to vegetative cells) that met acid resistance criteria (spores were resistant to 2.5 M HCl for 10 min). In addition, recovery from brushed stainless steel carriers with and without soil load was &gt;6 log10 spores/carrier. A 6 log10 performance standard was set forth in the EPA's interim guidance for generating data to support a label claim for effectiveness against C. difficile spores on hard, nonporous surfaces. This precollaborative investigation successfully demonstrated the use of a methodology for in vitro production of C. difficile spores (ATCC 43598) necessary for conducting efficacy tests. A proposal will be submitted to the AOAC INTERNATIONAL Methods Committee on Antimicrobial Efficacy Testing for a collaborative study; see Appendix.