Sarah Tschudin-Sutter1, Karen C Carroll2, Pranita D Tamma3, Madeleine L Sudekum1, Reno Frei4, Andreas F Widmer5, Brandon C Ellis2, John Bartlett1, Trish M Perl1. 1. 1Division of Infectious Diseases,Department of Medicine,Johns Hopkins University School of Medicine,Baltimore,Maryland. 2. 4Division of Medical Microbiology,Department of Pathology,Johns Hopkins Medical Institutions,Baltimore,Maryland. 3. 5Division of Pediatric Infectious Diseases,Department of Pediatrics,Johns Hopkins University School of Medicine,Baltimore,Maryland. 4. 6Division of Clinical Microbiology,University Hospital Basel,Basel,Switzerland. 5. 2Division of Infectious Diseases and Hospital Epidemiology,University Hospital Basel,Basel,Switzerland.
Abstract
BACKGROUND: Clostridium difficile infection (CDI) in hospitalized patients is generally attributed to the current stay, but recent studies reveal high C. difficile colonization rates on admission. OBJECTIVE: To determine the rate of colonization with toxigenic C. difficile among intensive care unit patients upon admission as well as acquired during hospitalization, and the risk of subsequent CDI. METHODS: Prospective cohort study from April 15 through July 8, 2013. Adults admitted to an intensive care unit within 48 hours of admission to the Johns Hopkins Hospital, Baltimore, Maryland, were screened for colonization with toxigenic C. difficile. The primary outcome was risk of developing CDI. RESULTS: Among 542 patients, 17 (3.1%) were colonized with toxigenic C. difficile on admission and an additional 3 patients were found to be colonized during hospitalization. Both colonization with toxigenic C. difficile on admission and colonization during hospitalization were associated with an increased risk for development of CDI (relative risk, 10.29 [95% CI, 2.24-47.40], P=.003; and 15.66 [4.01-61.08], P<.001, respectively). Using multivariable analysis, colonization on admission and colonization during hospitalization were independent predictors of CDI (relative risk, 8.62 [95% CI, 1.48-50.25], P=.017; and 10.93 [1.49-80.20], P=.019, respectively), while adjusting for potential confounders. CONCLUSIONS: In intensive care unit patients, colonization with toxigenic C. difficile is an independent risk factor for development of subsequent CDI. Further studies are needed to identify populations with higher toxigenic C. difficile colonization rates possibly benefiting from screening or avoidance of agents known to promote CDI.
BACKGROUND:Clostridium difficileinfection (CDI) in hospitalized patients is generally attributed to the current stay, but recent studies reveal high C. difficile colonization rates on admission. OBJECTIVE: To determine the rate of colonization with toxigenic C. difficile among intensive care unit patients upon admission as well as acquired during hospitalization, and the risk of subsequent CDI. METHODS: Prospective cohort study from April 15 through July 8, 2013. Adults admitted to an intensive care unit within 48 hours of admission to the Johns Hopkins Hospital, Baltimore, Maryland, were screened for colonization with toxigenic C. difficile. The primary outcome was risk of developing CDI. RESULTS: Among 542 patients, 17 (3.1%) were colonized with toxigenic C. difficile on admission and an additional 3 patients were found to be colonized during hospitalization. Both colonization with toxigenic C. difficile on admission and colonization during hospitalization were associated with an increased risk for development of CDI (relative risk, 10.29 [95% CI, 2.24-47.40], P=.003; and 15.66 [4.01-61.08], P<.001, respectively). Using multivariable analysis, colonization on admission and colonization during hospitalization were independent predictors of CDI (relative risk, 8.62 [95% CI, 1.48-50.25], P=.017; and 10.93 [1.49-80.20], P=.019, respectively), while adjusting for potential confounders. CONCLUSIONS: In intensive care unit patients, colonization with toxigenic C. difficile is an independent risk factor for development of subsequent CDI. Further studies are needed to identify populations with higher toxigenic C. difficile colonization rates possibly benefiting from screening or avoidance of agents known to promote CDI.
Authors: Massimo Antonelli; Ignacio Martin-Loeches; George Dimopoulos; Antonio Gasbarrini; Maria Sole Vallecoccia Journal: Intensive Care Med Date: 2020-01-14 Impact factor: 17.440
Authors: Larry K Kociolek; Dale N Gerding; Robyn O Espinosa; Sameer J Patel; Stanford T Shulman; Egon A Ozer Journal: Clin Infect Dis Date: 2018-07-02 Impact factor: 9.079
Authors: Sarah W Baron; Belinda E Ostrowsky; Priya Nori; David Y Drory; Michael H Levi; Wendy A Szymczak; Michael L Rinke; William N Southern Journal: Infect Control Hosp Epidemiol Date: 2020-02 Impact factor: 3.254
Authors: Aneela Majeed; Marti M Larriva; Ahmad Iftikhar; Adeela Mushtaq; Patrick Campbell; Mustafa Nadeem Malik; Abdul Rafae; Muhammad Abu Zar; Ahmad Kamal; Midhat Lakhani; Nageena Rani Khalid; Tirdad T Zangeneh; Faiz Anwer Journal: Infect Dis Clin Pract (Baltim Md) Date: 2020-01
Authors: Laura Behar; David Chadwick; Angela Dunne; Christopher I Jones; Claire Proctor; Chakravarthi Rajkumar; Paula Sharratt; Philip Stanley; Angela Whiley; Mark Wilks; Martin J Llewelyn Journal: J Infect Date: 2017-04-21 Impact factor: 6.072