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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)
Abstract
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)
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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...
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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...
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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...
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