One Health approach to Clostridioides difficile in Japan

J Infect Chemother. 2020 Jul;26(7):643-650. doi: 10.1016/j.jiac.2020.03.012. Epub 2020 Apr 23.


Clostridioides difficile infections (CDIs) are predominantly a healthcare-associated illness in developed countries, with the majority of cases being elderly and hospitalize patients who used antibiotic therapy. Recently, the incidence of community-associated CDIs (CA-CDIs) in younger patients without a previous history of hospitalization or antibiotic treatment has been increasing globally. C. difficile is sometimes found in the intestine of many animals, such as pigs, calves, and dogs. Food products such as retail meat products and vegetables sometimes contain C. difficile. C. difficile has also been isolated from several environments such as compost manure, rivers, and soils. Yet, direct transmission of C. difficile from animals, food products, and environments to humans has not been proven, although these strains have similar molecular characteristics. Therefore, it has been suggested that there is a relationship between CA-CDIs and C. difficile from animals, food products, and the environment. To clarify the importance of the presence of C. difficile in several sources, characterization of C. difficile in these sources is required. However, the epidemiology of C. difficile in animals, food products, and the environment is not well studied in Japan. This review summarizes recent trends of CDIs and compares the molecular characteristics of C. difficile in Japanese animals, food products, and the environment. The prevalence trends of C. difficile in Japan are similar to those in the rest of the world. Therefore, I recommend using a One Health approach to CDI surveillance, monitoring, and control.

Keywords: Animal; Clostridioides difficile; Community-associated infection; Environment; Food product; One Health.

Publication types

  • Review

MeSH terms

  • Animals
  • Cattle / microbiology
  • Clostridioides difficile / isolation & purification*
  • Clostridioides difficile / pathogenicity
  • Clostridium Infections / epidemiology*
  • Clostridium Infections / microbiology
  • Clostridium Infections / prevention & control
  • Clostridium Infections / veterinary
  • Communicable Disease Control / organization & administration*
  • Community-Acquired Infections / epidemiology
  • Community-Acquired Infections / microbiology
  • Community-Acquired Infections / prevention & control
  • Community-Acquired Infections / veterinary
  • Dogs / microbiology
  • Epidemiological Monitoring*
  • Feces / microbiology
  • Food Microbiology
  • Global Burden of Disease
  • Humans
  • Japan / epidemiology
  • Manure / microbiology
  • Meat Products / microbiology
  • One Health*
  • Prevalence
  • Rivers / microbiology
  • Soil Microbiology
  • Swine / microbiology
  • Vegetables / microbiology


  • Manure