Asymptomatic Clostridium difficile Colonization: Is This the Tip of Another Iceberg?

Muto, Carlene A.

doi:10.1086/521855

Cited by 22 publications

(15 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…From the epidemiological perspective, the incidence of toxigenic C. difficile remained static (0.53 per 1,000 admissions) between 2004 and 2008, but it suddenly increased to 0.95 per 1,000 admissions in 2009. Although the incidence was lower than some centers in Europe and was still within an acceptable limit of less than 5 cases per 1,000 admissions as recommended by some experts [55, 56], an 80% upsurge should alert both the physician and the infection control team to possible outbreaks of ribotype 002 before it could become established in our hospitals, as in the case of C. difficile PCR ribotype 027.…”

Section: Discussionmentioning

confidence: 81%

Clostridium difficile isolates with increased sporulation: emergence of PCR ribotype 002 in Hong Kong

Cheng

Yam

Lam

et al. 2011

Eur J Clin Microbiol Infect Dis

View full text Add to dashboard Cite

We identified a predominant clone of Clostridium difficile PCR ribotype 002, which was associated with an increased sporulation frequency. In 2009, 3,528 stool samples from 2,440 patients were tested for toxigenic C. difficile in a healthcare region in Hong Kong. A total of 345 toxigenic strains from 307 (13.3%) patients were found. Ribotype 002 was the predominant ribotype, which constituted 35 samples from 29 (9.4%) patients. The mean sporulation frequency of ribotype 002 was 20.2%, which was significantly higher than that of the 56 randomly selected ribotypes other than 002 as concurrent controls (3.7%, p < 0.001). Patients carrying toxigenic ribotype 002 were more frequently admitted from an elderly home (p = 0.01) and received more β-lactam antibiotics in the preceding 3 months compared with the controls (p = 0.04) . The identification of toxigenic ribotype 002 in 2009 was temporally related to a significant increase in both the incidence of toxigenic C. difficile from 0.53 to 0.95 per 1,000 admissions (p < 0.001) and the rate of positive detection from 4.17% to 6.28% (p < 0.001) between period 1 (2004–2008) and period 2 (2009). This finding should alert both the physician and the infection control team to the establishment of and possible outbreaks by ribotype 002 in our hospitals, as in the case of ribotype 027.

show abstract

Section: Discussionmentioning

confidence: 81%

Clostridium difficile isolates with increased sporulation: emergence of PCR ribotype 002 in Hong Kong

Cheng

Yam

Lam

et al. 2011

Eur J Clin Microbiol Infect Dis

View full text Add to dashboard Cite

show abstract

“…The early transmission of MDRO between the environment and patient is an important observation and points to the opportunity for development of effective prevention strategies of bacterial transmission. 15, 16 …”

Section: Resultsmentioning

confidence: 99%

A prospective study of transmission of Multidrug-Resistant Organisms (MDROs) between environmental sites and hospitalized patients—the TransFER study

Chen

Knelson

Gergen

et al. 2018

Infect. Control Hosp. Epidemiol.

View full text Add to dashboard Cite

Objective Hospital environmental surfaces are frequently contaminated by microorganisms. However, the causal mechanism of bacterial contamination of the environment as a source of transmission is still debated. This prospective study was performed to characterize the nature of multidrug-resistant organism (MDRO) transmission between the environment and patients using standard microbiological and molecular techniques. Setting Prospective cohort study at 2 academic medical centers. Design A prospective multicenter study to characterize the nature of bacterial transfer events between patients and environmental surfaces in rooms that previously housed patients with 1 of 4 ‘marker’ MDROs: methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Clostridium difficile, and MDR Acinetobacter baumannii. Environmental and patient microbiological samples were obtained on admission into a freshly disinfected inpatient room. Repeat samples from room surfaces and patients were taken on days 3 and 7 and each week the patient stayed in the same room. The bacterial identity, antibiotic susceptibility, and molecular sequences were compared between organisms found in the environment samples and patient sources. Results We enrolled 80 patient–room admissions; 9 of these patients (11.3%) were asymptomatically colonized with MDROs at study entry. Hospital room surfaces were contaminated with MDROs despite terminal disinfection in 44 cases (55%). Microbiological Bacterial Transfer events either to the patient, the environment, or both occurred in 12 patient encounters (18.5%) from the microbiologically evaluable cohort. Conclusions Microbiological Bacterial Transfer events between patients and the environment were observed in 18.5% of patient encounters and occurred early in the admission. This study suggests that research on prevention methods beyond the standard practice of room disinfection at the end of a patient’s stay is needed to better prevent acquisition of MDROs through the environment.

show abstract

“…Originally shown to cause disease primarily in hospitalized patients following antibiotic therapy, this organism is associated with intestinal disease ranging from mild diarrhea to pseudomembranous colitis, and is now being recognized as community-associated [5,6]. Many patients and healthy persons are asymptomatic carriers of the organism, and are transiently infected with the vegetative cells and spores [7,8]. Symptomatic infections and asymptomatic carriers are commonly seen in hospital patients and in nursing home patients.…”

Section: Introductionmentioning

confidence: 99%

Clostridium difficile prevalence rates in a large healthcare system stratified according to patient population, age, gender, and specimen consistency

Boone

Goodykoontz

Rhodes

et al. 2011

Eur J Clin Microbiol Infect Dis

View full text Add to dashboard Cite

We evaluated Clostridium difficile prevalence rates in 2,807 clinically indicated stool specimens stratified by inpatient (IP), nursing home patient (NH), outpatient (OP), age, gender, and specimen consistency using bacterial culture, toxin detection, and polymerase chain reaction (PCR) ribotyping. Rates were determined based on the detection of toxigenic C. difficile isolates. We identified significant differences in the rates between patient populations and with age. Specimens from NH had a higher rate (46%) for toxigenic C. difficile than specimens from IP (18%) and OP (17%). There were no gender-related differences in the rates. Liquid specimens had a lower rate (15%) than partially formed and soft specimens (25%) and formed specimens (18%) for the isolation of toxigenic C. difficile. The nontoxigenic rate was lowest for NH (4%) and highest for patients<20 years of age (23%). We identified 31 different toxigenic ribotypes from a sampling of 190 isolates that showed the lowest diversity in NH. Fluoroquinolone resistance was observed in 93% of the 027 isolates, all of the 053 isolates, and in four other ribotypes. We observed different rates for toxigenic C. difficile in stratified patient populations, with the highest rate for NH, a low overall nontoxigenic rate, and fluoroquinolone resistance.

show abstract

Asymptomatic Clostridium difficile Colonization: Is This the Tip of Another Iceberg?

Cited by 22 publications

References 22 publications

Clostridium difficile isolates with increased sporulation: emergence of PCR ribotype 002 in Hong Kong

Clostridium difficile isolates with increased sporulation: emergence of PCR ribotype 002 in Hong Kong

A prospective study of transmission of Multidrug-Resistant Organisms (MDROs) between environmental sites and hospitalized patients—the TransFER study

Clostridium difficile prevalence rates in a large healthcare system stratified according to patient population, age, gender, and specimen consistency

Contact Info

Product

Resources

About