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Background While human-to-human transmission of  Clostridioides difficile  occurs often, other infection sources, including food, animals and environment, are under investigation. Aim We present a large study on  C. difficile  in a food item in Europe, encompassing 12 European countries (Austria, France, Greece, Ireland, Italy, the Netherlands, Poland, Slovakia, Spain, Sweden, Romania and the United Kingdom). Methods Potato was selected because of availability, ease of sampling and high  C. difficile  positivity rates. Identical protocols for sampling and isolation were used, enabling a direct comparison of the  C. difficile  positivity rate. Results From  C. difficile -positive potato samples (33/147; 22.4%), we obtained 504 isolates, grouped into 38 PCR ribotypes. Positivity rates per country varied (0–100%) and were at least 10% in 9/12 countries. No geographical clustering of samples with high positivity rates or in PCR ribotype distribution was observed. The most frequently detected PCR ribotypes (014/020, 078/126, 010 and 023) are also commonly reported in Europe among human clinically relevant isolates, in animal isolates and in the environment. Whole genome sequencing revealed several genetically related strain pairs (Spain/RT126, France/RT010, Austria and Sweden/RT276) and a cluster of very similar strains in RT078/126. Conclusion Our results suggest, the high potato contamination rates could have public health relevance. They indicate potatoes can serve as a vector for introducing  C. difficile  spores in the household environment, where the bacterium can then multiply in sensitive hosts with disrupted or unmature microbiota. Potato contamination with PCR ribotypes shared between humans, animals and soil is supportive of this view.

Clostridioides difficile positivity rate and PCR ribotype distribution on retail potatoes in 12 European countries, January to June 2018