Patients admitted to an ICU for Clostridium difficile infection were at risk for developing subsequent C. difficile infections, according to recent research.
Trish M. Perl, MD, MSc, of the Johns Hopkins University School of Medicine, and colleagues prospectively screened 542 patients for C. difficile admitted to the ICU at Johns Hopkins Hospital between April and July 2013. Rectal swabs were used to screen for C. difficile at admission and weekly until ICU discharge. Patients also were monitored by medical chart review for 1 month after discharge.
The researchers found that 3.1% of patients admitted had toxigenic C. difficile colonization on admission, and three patients of 35 had a subsequent C. difficile infection during weekly follow-up. Colonization with toxigenic C. difficile before admission was associated with developing infection (RR = 10.29; 95% CI, 2.24–47.4), as was colonization during hospital stay (RR = 15.66; 95% CI, 4.01–61.08). After adjusting for confounders, the investigators found colonization before admission (RR = 8.62; 95% CI, 1.48–50.25) and during hospital stay (RR = 10.93; 95% CI, 1.49–80.2) were independent risk factors for infection.
Trish M. Perl
Perl and colleagues noted that age, use of proton pump inhibitors or antibiotics or prior health care visits up to 12 weeks were not associated with C. difficile infection. During their hospital stays, 1.5% of patients developed C. difficile infection; four patients were diagnosed within 1 month of discharge.
“Importantly in this study, colonization with toxigenic C. difficile on admission was identified as a strong and independent predictor for development of subsequent [C. difficile infection,]” the researchers wrote. “This finding suggests that traditional infection control measures may not suffice to avoid further increase in disease burden. For patients colonized with toxigenic C. difficile, the challenge for disease prevention is not to prevent exposure but to reduce the risk of C. difficile toxin expression by restricting use of antibiotics, acid-suppressive agents and narcotics.” – by Jeff Craven
Disclosure: Tschudin-Sutter reports funding from the Swiss National Science Foundation, the Medical Division of the Lichtenstein Foundation of the University of Basel and the Scientific Society Basel. All other authors report no relevant financial disclosures.