Colonization of Toxigenic Clostridium difficile Among Intensive Care Unit Patients: A Multi-Centre Cross-Sectional Study

Abstract

Background: Clostridium difficile (CD) is a major cause of healthcare-associated infections and antibiotic-associated diarrhea in hospitalized patients worldwide. Carriers of toxigenic CD (tCD) have a higher risk of developing CD infections and can transmit CD to the environment and susceptible patients. However, little is known regarding the carriers and transmission of tCD in China.Methods: A multi-center cross-sectional study of tCD colonization (tCDC) was conducted from October 24 to 31, 2014, at 33 hospitals in Shanghai, China. Rectal swabs or stool samples were collected and tested, and the clinical and demographic status, epidemiological data, and blood parameters of 531 participants were recorded. The status of tCDC was defined by a positive result on the nucleic acid amplification test for the tcdA (toxin A), tcdB (toxin B), and cdtAB (toxin CDT) genes after positive bacterial culture. Results:The overall prevalence of CD colonization (CDC) was 19.02%, tCDC accounted for 92.08%, and A+B+CDT-was the dominant genotype (87.13%). The CD infection (CDI) prevalence was 1.51%. Potential tCDC-associated factors were admission to secondary grade hospitals, a body mass index <18.5, hospitalization during the previous 30 days, underlying diseases (including hypertension, diabetes mellitus, coronary heart disease, and respiratory failure), diarrhea during the previous 7 days, and exposure to fluoroquinolones or lansoprazole.Conclusions: This study reveals the prevalence of CDC and tCDC in Shanghai, elucidates several associated factors, contributes to the awareness of the current epidemiology in parts of eastern China and provides new insights for further study and infection control practices.

Comparative genomic and transmission analysis of Clostridioides difficile between environmental, animal, and clinical sources in China

“…The prevalence of asymptomatic carriers in hospitals was much greater than that of CDI [ 8 ], and C. difficile strains isolated from newly admitted patients were community associated [ 9 ]. Notably, asymptomatic carriers carrying toxigenic C. difficile are six times more likely to develop CDI after admission to the hospital than non-carriers, thus becoming a direct source of CDI [ 10 ].…”

Clostridioides difficile colonization and the frequency of subsequent treatment for C. difficile infection in critically ill patients

“…3 Similarly, rates in the ICU have been reported to range from 1.7% to 19%. [8][9][10] The risk factors for C. difficile colonization included female sex, a history of diabetes, and a history of chronic kidney disease. We also detected higher rates of C. difficile colonization among patients with recent hospitalization, recent CDI treatment, or recent use of antibiotics, similar to what has been reported in the literature.…”

“…7 The relationship between C. difficile colonization and CDI in the ICU has been evaluated in several prior studies with mixed results. [8][9][10] Tschudin-Sutter et al 8 found that colonization with C. difficile was a risk factor for the development of CDI among ICU patients, although this risk factor was not identified in a similar study by Zhang et al 9 Notably, the study by Zhang et al was performed at a referral hospital in western China, and a baseline C. difficile colonization rate of only 1.7% was reported, lower than that reported in the Tschudin-Sutter study (3.1%) and other studies in non-ICU populations. 8,9 Our institution implemented a C. difficile screening protocol upon admission for hospitalized patients that began in targeted units in July 2015 and expanded to include all admitted patients in 2018.…”