The housefly Musca domestica as a mechanical vector of Clostridium difficile

Background - Clostridium difficile is a bacterial healthcare-associated infection that may be transferred by houseflies (Musca domestica) due to their close ecological association with humans and cosmopolitan nature.
Aim - To determine the ability of M. domestica to transfer C. difficile both mechanically and following ingestion.
Methods - M. domestica were exposed to independent suspensions of vegetative cells and spores of C. difficile, then sampled on to selective agar plates immediately postexposure and at 1-h intervals to assess the mechanical transfer of C. difficile. Fly excreta was cultured and alimentary canals were dissected to determine internalization of cells and spores.
Findings - M. domestica exposed to vegetative cell suspensions and spore suspensions of C. difficile were able to transfer the bacteria mechanically for up to 4 h upon subsequent contact with surfaces. The greatest numbers of colony-forming units (CFUs) per fly were transferred immediately following exposure (mean CFUs 123.8 +/− 66.9 for vegetative cell suspension and 288.2 +/− 83.2 for spore suspension). After 1 h, this had reduced (21.2 +/− 11.4 for vegetative cell suspension and 19.9 +/− 9 for spores). Mean C. difficile CFUs isolated from the M. domestica alimentary canal was 35 +/− 6.5, and mean C. difficile CFUs per faecal spot was 1.04 +/− 0.58. C. difficile could be recovered from fly excreta for up to 96 h.
Conclusion - This study describes the potential for M. domestica to contribute to environmental persistence and spread of C. difficile in hospitals, highlighting flies as realistic vectors of this micro-organism in clinical areas.