Asymptomatic carriage of toxigenic Clostridium difficile by hospitalized patients

Published on Oct 1, 2013in Journal of Hospital Infection3.704
· DOI :10.1016/j.jhin.2013.07.002
Dubert M. Guerrero6
Estimated H-index: 6
(Case Western Reserve University),
J.C. Becker1
Estimated H-index: 1
+ 4 AuthorsCurtis J. Donskey49
Estimated H-index: 49
(Case Western Reserve University)
Summary Asymptomatic carriage of Clostridium difficile is common in hospitals, but the risk for transmission by carriers is unclear. In this point prevalence culture survey of asymptomatic hospitalized patients, 18 of 149 (12%) were carriers of toxigenic C. difficile . By comparison with C. difficile infection (CDI) patients, the prevalence of skin and/or environmental contamination was significantly lower in asymptomatic carriers (3/18, 17% versus 5/6, 83%; P  = 0.007), but carriers outnumbered CDI patients in the hospital by a factor of 3 to 1. These data suggest that asymptomatic carriers have the potential to contribute to C. difficile transmission in hospitals.
  • References (10)
  • Citations (48)
📖 Papers frequently viewed together
129 Citations
491 Citations
408 Citations
78% of Scinapse members use related papers. After signing in, all features are FREE.
#1A. Sarah Walker (NIHR: National Institute for Health Research)H-Index: 17
#2David W. Eyre (NIHR: National Institute for Health Research)H-Index: 25
Last. Tunde Peto (NIHR: National Institute for Health Research)H-Index: 75
view all 12 authors...
Background Clostridium difficile infection (CDI) is a leading cause of antibiotic-associated diarrhoea and is endemic in hospitals, hindering the identification of sources and routes of transmission based on shared time and space alone. This may compromise rational control despite costly prevention strategies. This study aimed to investigate ward-based transmission of C. difficile, by subdividing outbreaks into distinct lineages defined by multi-locus sequence typing (MLST). Methods and Findings...
144 CitationsSource
A total of 4143 patients were included in the study; 117 (2.8%) and 123 (3.0%) had health care–associated C. difficile infection and colonization, respectively. Older age and use of antibiotics and proton-pump inhibitors were significantly associated with health care–associated C. difficile infection. Hospitalization in the previous 2 months; use of chemotherapy, proton-pump inhibitors, and H2 blockers; and antibodies against toxin B were associated with health care–associated C. difficile colon...
491 CitationsSource
#1Stuart H. Cohen (UC Davis: University of California, Davis)H-Index: 28
#2Dale N. Gerding (LUC: Loyola University Chicago)H-Index: 10
Last. Mark H. Wilcox (University of Leeds)H-Index: 77
view all 8 authors...
Since publication of the Society for Healthcare Epidemiology of America position paper on Clostridium difficile infection in 1995, significant changes have occurred in the epidemiology and treatment of this infection. C. difficile remains the most important cause of healthcareassociated diarrhea and is increasingly important as a community pathogen. A more virulent strain of C. difficile has been identified and has been responsible for more-severe cases of disease worldwide. Data reporting the d...
2,263 CitationsSource
Both for epidemiologic studies and for diagnostic testing, there is a need for effective, economical, and readily available selective media for the culture of Clostridium difficile. We have developed a reduced-cost substitute for cycloserine-cefoxitin-fructose agar (CCFA), which is an effective but expensive selective medium for C. difficile. The modified medium, called C. difficile brucella agar (CDBA), includes an enriched brucella base as a substitute for proteose peptone no. 2, and the conce...
65 CitationsSource
#1Michelle M. RiggsH-Index: 6
#2Ajay K. Sethi (Case Western Reserve University)H-Index: 25
Last. Curtis J. DonskeyH-Index: 49
view all 6 authors...
Background. Asymptomatic fecal carriage of Clostridium difficile is common in patients staying in health care facilities, but the importance of asymptomatic carriers with regard to disease transmission is unclear.Methods. We prospectively examined the prevalence of asymptomatic carriage of epidemic North American pulsed-field gel electrophoresis type 1 and nonepidemic toxigenic C. difficile strains among long-term care patients in the context of an outbreak of C. difficile–associated disease and...
408 CitationsSource
#1Jon P. Furuno (UMB: University of Maryland, Baltimore)H-Index: 26
#2Jessina C. McGregor (UMB: University of Maryland, Baltimore)H-Index: 25
Last. Eli N. PerencevichH-Index: 56
view all 11 authors...
Background No simple, cost-effective methods exist to identify patients at high risk for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci colonization outside intensive care settings. Without such methods, colonized patients are entering hospitals undetected and transmitting these bacteria to other patients. We aimed to develop a highly sensitive, simple-to-administer prediction rule to identify subpopulations of patients at high risk for colonization on hospital ...
88 CitationsSource
#1Janet K Shim (NU: Northwestern University)H-Index: 2
#2Stuart Johnson (NU: Northwestern University)H-Index: 22
Last. Dale N. Gerding (NU: Northwestern University)H-Index: 37
view all 5 authors...
Summary Background Little is known about whether patients who develop Clostridium-difficile -associated diarrhoea (CDAD) are culture-positive or culture-negative before illness. The most important risk factor is antibiotic exposure. We aimed to find out whether patients identified as primary symptom-free C difficile carriers are at higher risk of developing CDAD than patients who are culture-negative. Method We reviewed four longitudinal studies in which 810 patients admitted to hospital were fo...
320 CitationsSource
#1Connie ClabotsH-Index: 38
#2Stuart JohnsonH-Index: 47
Last. Dale N. GerdingH-Index: 64
view all 5 authors...
The frequency of introduction and spread of specific Clostridium difficile strains among hospitalized patients were assessed by serial cultures of patients admitted to a medical-surgical ward with endemic C. tf/j^id/e-associated diarrhea. Stool cultures were obtained from 634 (940Zo) of 678 consecutive admissions to the ward (ward admissions), and all C difficile isolates were typed by restriction endonuclease analysis. Sixty-five ward admissions introduced C difficile to the ward, and 54 initia...
371 CitationsSource
Abstract We studied the acquisition and transmission of Clostridium difficile infection prospectively on a general medical ward by serially culturing rectal-swab specimens from 428 patients admitted over an 11-month period. Immunoblot typing was used to differentiate individual strains of C. difficile. Seven percent of the patients (29) had positive cultures at admission. Eighty-three (21 percent) of the 399 patients with negative cultures acquired C. difficile during their hospitalizations. Of ...
1,146 CitationsSource
#1Kyung-Hee Kim (UM: University of Michigan)H-Index: 4
#2Robert Fekety (UM: University of Michigan)H-Index: 30
Last. D. Waters (UM: University of Michigan)H-Index: 1
view all 7 authors...
Clostridium difficile is the most important cause of antibiotic-associated colitis, but its epidemiology remains unknown. Using a selective medium for the isolation of C. difficile, cultures were obtained from the environment and contacts of hospitalized patients carrying C. difficile in their stools. In areas where carriers had diarrhea, 85 (9.3%) of 910 cultures of floors and other surfaces, especially those subject to fecal contamination, were positive. In areas where there were no known carr...
384 CitationsSource
Cited By48
#1Nicholas A. Turner (Duke University)H-Index: 7
#2Deverick J. Anderson (Duke University)H-Index: 47
Clostridioides difficile remains a leading cause of healthcare-associated infection. Efforts at C. difficile prevention have been hampered by an increasingly complex understanding of transmission patterns and a high degree of heterogeneity among existing studies. Effective prevention of C. difficile infection requires multimodal interventions, including contact precautions, hand hygiene with soap and water, effective environmental cleaning, use of sporicidal cleaning agents, and antimicrobial st...
#1M. Gilboa (TAU: Tel Aviv University)
#2E. Houri-Levi (TAU: Tel Aviv University)
Last. Gili Regev-Yochay (TAU: Tel Aviv University)H-Index: 24
view all 11 authors...
Abstract Objectives To compare the burden of environmental shedding of toxigenic C. difficile among asymptomatic carriers, C. difficile infected (CDI) patients and non-carriers, in an inpatient non-epidemic setting. Methods C. difficile carriage was determined by positive toxin-B PCR from rectal swabs of asymptomatic patients. Active CDI was defined as a positive 2-step EIA/PCR test in patients with >3 unformed stools/24 hours. C. difficile environmental contamination was assessed by obtaining s...
#1Mayan Gilboa (Sheba Medical Center)H-Index: 1
#1M. Gilboa (Sheba Medical Center)
Last. Gili Regev-Yochay (Sheba Medical Center)H-Index: 24
view all 11 authors...
Objectives: To compare the burden of environmental shedding of toxigenic C. difficile among asymptomatic carriers, C. difficile infected (CDI) patients and non-carriers, in an inpatient non-epidemic setting. Methods: C. difficile carriage was determined by positive toxin-B PCR from rectal swabs of asymptomatc patients. Active CDI was defined as a positive 2-step EIA/PCR test in patients with >3 unformed stools/24 hours. C. difficile environmental contamination was assessed by obtaining specimens...
#1Ravina KullarH-Index: 17
#1Sarah BaronH-Index: 1
#1Sarah W. Baron (Montefiore Medical Center)H-Index: 1
Last. William N. SouthernH-Index: 14
view all 8 authors...
Objective: Efforts to reduce Clostridioides difficile infection (CDI) have targeted transmission from patients with symptomatic C. difficile . However, many patients with the C. difficile organism are carriers without symptoms who may serve as reservoirs for spread of infection and may be at risk for progression to symptomatic C. difficile . To estimate the prevalence of C. difficile carriage and determine the risk and speed of progression to symptomatic C. difficile among carriers, we establish...
1 CitationsSource
#1Nicholas A. Turner (Duke University)H-Index: 7
#2Steven C. Grambow (Duke University)H-Index: 31
Last. Sarah S. Lewis (Duke University)H-Index: 12
view all 7 authors...
Importance Clostridioides difficileinfection (CDI) remains a leading cause of health care facility–associated infection. A greater understanding of the regional epidemiologic profile of CDI could inform targeted prevention strategies. Objectives To assess trends in incidence of health care facility–associated and community-acquired CDI among hospitalized patients over time and to conduct a subanalysis of trends in the NAP1 strain of CDI over time. Design, Setting, and Participants This long-term...
1 CitationsSource
#1Kathleen M. Mullane (U of C: University of Chicago)H-Index: 30
#2Erik R. Dubberke (WashU: Washington University in St. Louis)H-Index: 42
#1Yilen K. Ng WongH-Index: 2
#2Heba AlhmidiH-Index: 6
Last. Curtis J. Donskey (Case Western Reserve University)H-Index: 49
view all 6 authors...
The frequency of recovery of Clostridium difficile spores from surfaces after postdischarge cleaning of non-C difficile infection rooms was significantly reduced from 24%-5% after a commercial spray formulation of bleach was substituted for a quaternary ammonium disinfectant. These results suggest that routine use of a sporicidal disinfectant in all postdischarge rooms could potentially be beneficial in reducing the risk for C difficile transmission from contaminated surfaces.
2 CitationsSource
#1Matthew Ziegler (UPenn: University of Pennsylvania)H-Index: 2
#2Daniel J. Landsburg (UPenn: University of Pennsylvania)H-Index: 18
Last. Jennifer H. Han (UPenn: University of Pennsylvania)H-Index: 13
view all 14 authors...
Abstract Patients undergoing stem cell transplant (SCT) for the treatment of hematologic malignancy are at increased risk for central line–associated bloodstream infections (CLABSIs). The use of prophylactic antibiotics to prevent CLABSIs in the setting of autologous SCT is of unclear benefit. We aimed to evaluate the impact of levofloxacin prophylaxis on reducing CLABSIs in this high-risk population. Patients undergoing autologous SCT at a tertiary care hospital received levofloxacin prophylaxi...
2 CitationsSource
#1Farida Chamchod (MU: Mahidol University)H-Index: 4
#2Prasit Palittapongarnpim (MU: Mahidol University)H-Index: 18
Background Clostridium difficile (C. difficile) infection is an important cause of healthcare-associated diarrhea. Several factors such as admission of colonized patients, levels of serum antibodies in patients, and control strategies may involve in determining the prevalence and the persistence of C. difficile in a hospital unit.