Assessing the effect of patient screening and isolation on curtailing Clostridium difficile infection in hospital settings

Abstract

BackgroundPatient screening at the time of hospital admission is not recommended as a routine practice, but may be an important strategy for containment of Clostridium difficile infection (CDI) in hospital settings. We sought to investigate the effect of patient screening in the presence of asymptomatic carriers and in the context of imperfect patient isolation.MethodsWe developed and parameterized a stochastic simulation model for the transmission dynamics of CDI in a hospital ward.ResultsWe found that the transmission of CDI in the hospital, either through asymptomatic carriers or as a results of ineffective implementation of infection control practices, at the time of hospital admission. The results show that, for a sufficiently high reproduction number of CDI, the disease can persist within a hospital setting in the presence of in-ward transmission, even when there are no asymptomatically colonized patients at the time of hospital admission.ConclusionsOur findings have significant public health and clinical implications, especially in light of the emergence and community spread of hypervirulent CDI strains with enhanced transmission rates and toxin production. Rapid detection of colonized patients remains an important component of CDI control, especially in the context of asymptomatic transmission. Screening of in-hospital patients with potential exposure to colonized patients or contaminated environment and equipment can help reduce the rates of silent transmission of CDI through asymptomatic carriers.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-017-2494-6) contains supplementary material, which is available to authorized users.

Prevalence, genotype and antimicrobial resistance of Clostridium difficile isolates from healthy pets in Eastern China

“…The prevalence of CDI has increased globally due to inappropriate use of antibiotics. Many articles have reported the molecular epidemiology of C. difficile isolated from patients in hospitals, which has been studied extensively as an external source of CDI [6]. Additionally, some human pathogenic PCR ribotypes are found in other mammals, such as pigs, horses, and cattle.…”

Clinical prediction rule for identifying older patients with toxigenic Clostridioides difficile at the time of hospital admission

“…However, current guidelines do not recommend active surveillance or the isolation of asymptomatic C. di cile carriers as measures to prevent C. di cile transmission. However, several studies have shown that active screening for C. di cile colonization using PCR assays is effective for infection control and prevention of C. di cile infection [10][11][12]. Ongoing research on new strategies, such as screening for asymptomatic C. di cile infections, is needed to optimize the containment of these infections.…”

“…Early recognition of toxigenic C. di cile infection on hospital admission is essential for timely infection control measures to contain the transmission of nosocomial CDI [10][11][12]. Asymptomatic toxigenic C. di cile carriers are also a high-risk group for progression to symptomatic CDI, for which antimicrobial stewardship measures should be instituted.…”

Clinical prediction rule for identifying older patients with toxigenic Clostridioides difficile at the time of hospital admission

“…However, data on the prevalence and risk factors for toxigenic C. di cile carriage on hospital admission in older populations are limited.Nucleic acid ampli cation testing (NAAT) is the only diagnostic test for the detection of toxigenic C. di cile used in many studies and may result in CDI overdiagnosis [8]. NAAT screening tools for CDI are, however, widely implemented because asymptomatic toxigenic C. di cile carriage is a major risk factor for CDI [9].Early recognition of toxigenic C. di cile infection on hospital admission is essential for timely infection control measures to contain the transmission of nosocomial CDI [10][11][12]. Asymptomatic toxigenic C. di cile carriers are also at high risk for progression to symptomatic CDI, for which antimicrobial stewardship measures should be implemented.…”

“…Early recognition of toxigenic C. di cile infection on hospital admission is essential for timely infection control measures to contain the transmission of nosocomial CDI [10][11][12]. Asymptomatic toxigenic C. di cile carriers are also at high risk for progression to symptomatic CDI, for which antimicrobial stewardship measures should be implemented.…”