In the Journals

Asymptomatic C. difficile colonization prevalent at hospital admission

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April 24, 2014

Colonization with toxigenic Clostridium difficile was prevalent among asymptomatic individuals who were admitted to the hospital, researchers from Washington University School of Medicine found.

“There is a large reservoir of hospitalized patients colonized with C. difficile,” Erik Dubberke, MD, MSPH, associate professor of medicine at Washington University School of Medicine, told Infectious Disease News. “Additional research is needed to know how to best prevent transmission of C. difficile from these patients and to prevent these patients from developing C. difficile infection.”

Erik Dubberke, MD 

Erik Dubberke

The study included 259 patients who were prospectively enrolled from June 2010 to October 2011. All of the patients had an anticipated hospital stay of more than 48 hours and provided either a stool specimen or rectal swab within 48 hours of admission. The specimens were cultured and the C. difficile isolates underwent ribotyping.

Toxigenic C. difficile (TCD) was isolated from 40 patients (15.4%) and non-toxigenic C. difficile was isolated from 15 patients (5.8%). The remaining 204 patients were not colonized. There were no differences between the TCD-colonized patients and the uncolonized patients in terms of age, comorbidities, admission from another health care facility or recent hospitalizations. In addition, there was no difference in recent antimicrobial exposure between the groups.

Among the 40 TCD isolates, there were 12 different strain types, of which of which two were not seen among patients with CDI during the study period. However, the prevalence of the other strains were different than the prevalence of those strains in patients at the hospital with CDI.

“It may be premature to use these results to affect current practice,” Dubberke said. “How these asymptomatic carriers contribute to new CDI cases in the hospital needs to be better characterized, and the efficacy of interventions to prevent new CDI cases based on identifying asymptomatic carriers needs to be determined.”

Dubberke said in future studies, he hopes to better identify all sources of C. difficile acquisition in the hospital and study interventions to prevent transmission of C. difficile and the development of CDI.

Disclosure: The researchers report financial relationships with Accelerate Diagnostics, bioMerieux, Cepheid, Merck, Optimer/Cubist, Rebiotix, Sanofi-Pasteur, T2 Biosystems and Viropharma.

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