Acquisition of Clostridium difficile by Hospitalized Patients: Evidence for Colonized New Admissions as a Source of Infection

Abstract

The frequency of introduction and spread of specific Clostridium difficile strains among hospitalized patients were assessed by serial cultures of patients admitted to a medical-surgical ward with endemic C. difficile-associated diarrhea. Stool cultures were obtained from 634 (94%) of 678 consecutive admissions to the ward (ward admissions), and all C. difficile isolates were typed by restriction endonuclease analysis. Sixty-five ward admissions introduced C. difficile to the ward, and 54 initially culture-negative admissions acquired C. difficile on the ward. Ward admissions hospitalized within the prior 30 days in the medical center were more likely to be culture-positive for C. difficile at admission to the study ward than those not previously hospitalized at the institution (16% vs. 7%, P less than .001). Nosocomial acquisition of a C. difficile strain was preceded by a documented introduction of that strain to the ward by another asymptomatic ward admission in 16 (84%) of 19 instances, suggesting that C. difficile-colonized new admissions are a major source of nosocomial C. difficile infections.

Alternative treatments for Clostridium difficile disease: what really works?

“…Asymptomatic carriers of C. difficile have been shown to be a source of new nosocomial cases of CDAD (McFarland et al, 1989;Johnson et al, 1990;Clabots et al, 1992;Shim et al, 1998). In order to control the spread of C. difficile, a policy of treating asymptomatic carriers has been tested by several investigators.…”

Effectiveness of Screening Hospital Admissions to Detect Asymptomatic Carriers of Clostridium difficile: A Modeling Evaluation

“…11 Consequently, CDI might be more effectively controlled by targeting additional sources of C. difficile transmission beyond clinical cases. Asymptomatic colonization prevalence for C. difficile among admitted patients has been reported to be up to 20%, 6,13,14 and admitted colonized patients may play an important role in sustaining C. difficile transmission in acute healthcare facilities. Therefore, preventing secondary infection transmission from asymptomatic colonized patients can be an additional control point to decrease CDI burden in hospitals.…”

N‐CDAD in Canada: Results of the Canadian Nosocomial Infection Surveillance Program 1997 N‐CDAD Prevalence Surveillance Project

“…Because elderly people and those exposed to large amounts of antibiotics have a higher risk of acquiring CDAD, they are commonly surveyed (15,20,21). Specific wards (eg, medical and surgical) where the rates of CDAD are higher are also more frequently studied (2,6,22,23). Multicentre and national surveillance of CDAD in North America and Europe is rare (24)(25)(26)(27)(28).…”