Andreas F Widmer1, Reno Frei2, Stefan Erb1, Anne Stranden1, Ed J Kuijper3, Cornelis W Knetsch3, Sarah Tschudin-Sutter1. 1. Divisions of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University Basel, Basel, Switzerland. 2. Divisions of Clinical Microbiology, University Hospital Basel, University of Basel, Switzerland. 3. Section of Experimental Microbiology, Department of Medical Microbiology, Center of Infectious Diseases, Leiden University Medical Center, The Netherlands.
Abstract
Background: Contact precautions are recommended by health authorities in Europe and the United States for patients with Clostridium difficile infection (CDI). Recently, the significance of nosocomial transmission has been challenged by screening on admission studies and whole-genome sequencing, providing evidence for an endogenous source of C. difficile. We discontinued contact precautions for patients with CDI, except for patients infected with hypervirulent ribotypes or with stool incontinence, to determine the rate of transmission. Methods: From January 2004 to December 2013, contacts of each index case with CDI were screened for toxigenic C. difficile by culturing rectal swabs. Transmission was defined as possible if toxigenic C. difficile was detected in contacts, as probable if the identical polymerase chain reaction ribotype was identified in index–contact pairs, and as confirmed if next-generation sequencing (NGS) revealed clonality of strains. Results: Four hundred fifty-one contacts were exposed to 279 index patients nursed in 2-to 4-bed rooms. Toxigenic C. difficile was detected in 6.0% (27/451) after a median contact time of 5 days. Identical ribotypes were identified in 6 index–contact pairs, accounting for probable transmission in 1.3% (6/451). NGS was performed for 4 of 6 pairs with identical strains, and confirmed transmission in 2 contact patients. Conclusions: The rate of transmission of toxigenic, predominantly nonhypervirulent C. difficile, was low and no outbreaks were recorded over a 10-year period after discontinuing contact precautions for patients with CDI who were not severely incontinent and who used dedicated toilets. As contact precautions may lead to lower levels of care, their implementation needs to be balanced against the risk of nosocomial transmission.
Background: Contact precautions are recommended by health authorities in Europe and the United States for patients with Clostridium difficile infection (CDI). Recently, the significance of nosocomial transmission has been challenged by screening on admission studies and whole-genome sequencing, providing evidence for an endogenous source of C. difficile. We discontinued contact precautions for patients with CDI, except for patients infected with hypervirulent ribotypes or with stool incontinence, to determine the rate of transmission. Methods: From January 2004 to December 2013, contacts of each index case with CDI were screened for toxigenic C. difficile by culturing rectal swabs. Transmission was defined as possible if toxigenic C. difficile was detected in contacts, as probable if the identical polymerase chain reaction ribotype was identified in index–contact pairs, and as confirmed if next-generation sequencing (NGS) revealed clonality of strains. Results: Four hundred fifty-one contacts were exposed to 279 index patients nursed in 2-to 4-bed rooms. Toxigenic C. difficile was detected in 6.0% (27/451) after a median contact time of 5 days. Identical ribotypes were identified in 6 index–contact pairs, accounting for probable transmission in 1.3% (6/451). NGS was performed for 4 of 6 pairs with identical strains, and confirmed transmission in 2 contact patients. Conclusions: The rate of transmission of toxigenic, predominantly nonhypervirulent C. difficile, was low and no outbreaks were recorded over a 10-year period after discontinuing contact precautions for patients with CDI who were not severely incontinent and who used dedicated toilets. As contact precautions may lead to lower levels of care, their implementation needs to be balanced against the risk of nosocomial transmission.
Authors: Nina Van Goethem; Tine Descamps; Brecht Devleesschauwer; Nancy H C Roosens; Nele A M Boon; Herman Van Oyen; Annie Robert Journal: Implement Sci Date: 2019-08-13 Impact factor: 7.327
Authors: Bobby G Warren; Nicholas A Turner; Rachel Addison; Alicia Nelson; Aaron Barrett; Bechtler Addison; Amanda Graves; Becky Smith; Sarah S Lewis; David J Weber; Emily E Sickbert-Bennett; Deverick J Anderson Journal: Open Forum Infect Dis Date: 2022-02-09 Impact factor: 3.835
Authors: Danielle Vuichard-Gysin; Reto Nueesch; Raffaela Laura Fuerer; Marc Dangel; Andreas Widmer Journal: BMJ Open Date: 2022-03-21 Impact factor: 2.692
Authors: Helena M B Seth-Smith; Michael Biggel; Tim Roloff; Vladimira Hinic; Thomas Bodmer; Martin Risch; Carlo Casanova; Andreas Widmer; Rami Sommerstein; Jonas Marschall; Sarah Tschudin-Sutter; Adrian Egli Journal: Front Cell Infect Microbiol Date: 2021-06-01 Impact factor: 5.293