No abstract

Performing PCR instead of EIA/CCA is associated with a >50% increase in the CDI incidence rate. Standardization of diagnostic methods may be indicated to improve interhospital comparison.

Background Asymptomatic patients colonized with Clostridioides difficile are at risk of developing C. difficile infection (CDI), but the factors associated with disease onset are poorly understood. Our aims were to identify predictors of hospital-onset CDI (HO-CDI) among colonized patients and to explore the potential benefits of primary prophylaxis to prevent CDI. Methods We conducted a retrospective cohort study in a tertiary academic institution. Colonized patients were identified by detecting the tcdB gene by polymerase chain reaction on a rectal swab. Univariate and multivariate logistic regression analyses were used to identify predictors of HO-CDI. Results There were 19 112 patients screened, from which 960 (5%) colonized patients were identified: 513 met the inclusion criteria. Overall, 39 (7.6%) developed a HO-CDI, with a 30-day attributable mortality of 15%. An increasing length of stay (adjusted odds ratio [aOR] per day, 1.03; P = .006), exposure to multiple classes of antibiotics (aOR per class, 1.45; P = .02), use of opioids (aOR, 2.78; P = .007), and cirrhosis (aOR 5.49; P = .008) were independently associated with increased risks of HO-CDI, whereas the use of laxatives was associated with a lower risk of CDI (aOR 0.36; P = .01). Among the antimicrobials, B-lactam with B-lactamase inhibitors (OR 3.65; P < .001), first-generation cephalosporins (OR 2.38; P = .03), and carbapenems (OR 2.44; P = .03) correlated with the greatest risk of HO-CDI. By contrast, patient age, the use of proton pump inhibitors, and the use of primary prophylaxis were not significant predictors of HO-CDI. Conclusions This study identifies several factors that are associated with CDI among colonized patients. Whether modifying these variables could decrease the risk of CDI should be investigated.

During 4 Clostridium difficile infection outbreaks, unit-wide screening of 114 patients led to detection and isolation of 15 (13%) C. difficile asymptomatic carriers. Carriage prevalence varied between outbreaks, from 0% to 29% (P = .004). Isolating carriers was not associated with significantly shorter outbreak durations, compared with historical controls.

Isolating CD carriers led to an initial increase in isolation needs that was partially compensated by a decrease in isolation needs for CDI.

Cell cytotoxicity neutralization assay (CCNA) is considered to be a gold standard to diagnose Clostridioides difficile infections. We performed CCNA on 77 consecutive admission screening rectal swabs from asymptomatic toxigenic C. difficile carriers. Thirty-nine percent of specimens from asymptomatic carriers were positive. Thus, CCNA specificity may be lower than previously thought.

No abstract

Objectives: In Quebec, Canada, we evaluated the risk of SARS-CoV-2 infection associated with: 1) the demographic and employment characteristics among healthcare workers (HCWs); and 2) the workplace and household exposures and the infection prevention and control (IPC) measures among patient-facing HCWs. Design: Test-negative case-control study Setting: Provincial health system Participants: HCWs with PCR-confirmed COVID-19 diagnosed between November 15, 2020 and May 29, 2021 (cases) were compared to HCWs with compatible symptoms but testing negative during the same period (controls). Methods: Adjusted odds ratios (aOR) of infection were estimated using regression logistic models evaluating demographic and employment characteristics (all 4919 cases and 4803 controls) or household and workplace exposures and IPC measures (2046 patient-facing cases and 1362 controls). Results: COVID-19 risk was associated with working as housekeeping staff (aOR=3.6), patient support assistants (aOR=1.9) and nursing staff (aOR=1.4) (compared to administrative staff), being unexperienced (aOR=1.5) and working in private seniors’ homes (aOR=2.1) and long-term care (aOR=1.5) facilities (compared to acute-care hospitals). Among patient-facing HCWs, exposure to a household contact was reported by 9% of cases and was associated with the highest risk of infection (aOR=7.8). Most infections were likely attributable to the more frequent exposure to infected patients (aOR=2.7) and coworkers (aOR=2.2). Wearing a N95 respirator during contacts with COVID-19 patients (aOR=0.7) and vaccination (aOR=0.2) were the measures associated with a risk reduction. Conclusion: In the context of the ever-changing SARS-CoV-2 virus with increasing transmissibility, measures to ensure HCWs’ protection, including vaccination and respiratory protection, and patients’ safety will need ongoing evaluation.