Sarah W Baron1,2,3, Belinda E Ostrowsky4,2,3, Priya Nori4,2,3, David Y Drory3, Michael H Levi5,2,3, Wendy A Szymczak5,2,3, Michael L Rinke6,2,3, William N Southern1,2,3. 1. Division of Hospital Medicine, Department of Medicine, Montefiore Medical Center, Bronx, New York. 2. Montefiore Medical Center, Bronx, New York. 3. Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York. 4. Division of Infectious Disease, Department of Medicine, Montefiore Medical Center, Bronx, New York. 5. Department of Pathology, Montefiore Medical Center, Bronx, New York. 6. Division of Pediatric Hospital Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York.
Abstract
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 established a pilot screening program in a large urban hospital. DESIGN: Prospective cohort study. SETTING: An 800-bed, tertiary-care, academic medical center in the Bronx, New York. PARTICIPANTS: A sample of admitted adults without diarrhea, with oversampling of nursing facility patients. METHODS: Perirectal swabs were tested by polymerase chain reaction for C. difficile within 24 hours of admission, and patients were followed for progression to symptomatic C. difficile. Development of symptomatic C. difficile was compared among C. difficile carriers and noncarriers using a Cox proportional hazards model. RESULTS: Of the 220 subjects, 21 (9.6%) were C. difficile carriers, including 10.2% of the nursing facility residents and 7.7% of the community residents (P = .60). Among the 21 C. difficile carriers, 8 (38.1%) progressed to symptomatic C. difficile, but only 4 (2.0%) of the 199 noncarriers progressed to symptomatic C. difficile (hazard ratio, 23.9; 95% CI, 7.2-79.6; P < .0001). CONCLUSIONS: Asymptomatic carriage of C. difficile is prevalent among admitted patients and confers a significant risk of progression to symptomatic CDI. Screening for asymptomatic carriers may represent an opportunity to reduce CDI.
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 established a pilot screening program in a large urban hospital. DESIGN: Prospective cohort study. SETTING: An 800-bed, tertiary-care, academic medical center in the Bronx, New York. PARTICIPANTS: A sample of admitted adults without diarrhea, with oversampling of nursing facility patients. METHODS: Perirectal swabs were tested by polymerase chain reaction for C. difficile within 24 hours of admission, and patients were followed for progression to symptomatic C. difficile. Development of symptomatic C. difficile was compared among C. difficile carriers and noncarriers using a Cox proportional hazards model. RESULTS: Of the 220 subjects, 21 (9.6%) were C. difficile carriers, including 10.2% of the nursing facility residents and 7.7% of the community residents (P = .60). Among the 21 C. difficile carriers, 8 (38.1%) progressed to symptomatic C. difficile, but only 4 (2.0%) of the 199 noncarriers progressed to symptomatic C. difficile (hazard ratio, 23.9; 95% CI, 7.2-79.6; P < .0001). CONCLUSIONS: Asymptomatic carriage of C. difficile is prevalent among admitted patients and confers a significant risk of progression to symptomatic CDI. Screening for asymptomatic carriers may represent an opportunity to reduce CDI.
Authors: Suresh Ponnada; Dubert M Guerrero; Lucy A Jury; Michelle M Nerandzic; Jennifer L Cadnum; M Jahangir Alam; Curtis J Donskey Journal: Infect Control Hosp Epidemiol Date: 2017-07-11 Impact factor: 3.254
Authors: D M Guerrero; J C Becker; E C Eckstein; S Kundrapu; A Deshpande; A K Sethi; C J Donskey Journal: J Hosp Infect Date: 2013-08-14 Impact factor: 3.926
Authors: Vivian G Loo; Anne-Marie Bourgault; Louise Poirier; François Lamothe; Sophie Michaud; Nathalie Turgeon; Baldwin Toye; Axelle Beaudoin; Eric H Frost; Rodica Gilca; Paul Brassard; Nandini Dendukuri; Claire Béliveau; Matthew Oughton; Ivan Brukner; Andre Dascal Journal: N Engl J Med Date: 2011-11-03 Impact factor: 91.245
Authors: Jacek Czepiel; Mirosław Dróżdż; Hanna Pituch; Ed J Kuijper; William Perucki; Aleksandra Mielimonka; Sarah Goldman; Dorota Wultańska; Aleksander Garlicki; Grażyna Biesiada Journal: Eur J Clin Microbiol Infect Dis Date: 2019-04-03 Impact factor: 3.267
Authors: Brandon J Webb; Aruna Subramanian; Bert Lopansri; Bruce Goodman; Peter Bjorn Jones; Jeffrey Ferraro; Edward Stenehjem; Samuel M Brown Journal: Antimicrob Agents Chemother Date: 2020-03-24 Impact factor: 5.191
Authors: Nagham Khanafer; Philippe Vanhems; Sabrina Bennia; Géraldine Martin-Gaujard; Laurent Juillard; Thomas Rimmelé; Laurent Argaud; Olivier Martin; Laetitia Huriaux; Guillaume Marcotte; Romain Hernu; Bernard Floccard; Pierre Cassier; Study Group Journal: Int J Environ Res Public Health Date: 2021-07-15 Impact factor: 3.390