Clostridioides difficile as a potential foodborne pathogen laboratory and clinical perspectives

Clostridioides difficile is still recognized as a leading cause of diarrhea in hospitals, but an increasing number of cases occur in individuals without a history of hospitalization or recent antibiotic treatment. Recent literature data indicate the presence of C. difficile in farm animals, as well as in food and food processing. This has raised concerns about the potential spread of toxigenic strains of C. difficile through the food chain. This narrative review summarises the current state of knowledge regarding the classification, evolution, genetic diversity, pathogenic mechanisms, and potential routes and vectors of C. difficile spread. In this context, this review examines the literature evidence for contamination of meat, vegetables, dairy products, seafood, and other food products, as well as how these pathogens may be distributed via manure, sewage, and food processing environments. Particular attention was paid to the epidemiologically important ribotypes RT027 and RT078, which have been reported in human, animal and food collections. Their toxin production, antimicrobial susceptibility and clinical effects vary between isolates and cannot be inferred from ribotype alone. Significant gaps remain in our understanding of whether foodborne transmission can directly cause disease. A thorough risk assessment is necessary. Direct molecular evidence and sufficient data linking foodborne illness to new cases in the general population are currently lacking. This review, based on the One Health approach, highlights the need to address these gaps and implement integrated food safety strategies. It also highlights the need to limit the spread of high-risk strains in clinical, agricultural, and environmental settings. Emerging literature suggests that C. difficile is a pathogen relevant to the One Health framework. Although not yet fully demonstrated, food-borne transmission routes are possible.