Colonization With Toxinogenic C. difficile Upon Hospital Admission, and Risk of Infection: A Systematic Review and Meta-Analysis

Abstract

Over 8% of admitted patients are carriers of toxinogenic C. difficile with an almost 6 times higher risk of infection. These findings update current knowledge regarding the contribution of colonization in CDI epidemiology and stress the importance of preventive measures toward colonized patients.

Cirrhosis and C. difficile: A Deadly Duo?

“…With the concern that asymptomatic, colonized patients with cirrhosis may be at risk for CDI development, Saab et al support their screening recommendation by referencing papers by Zacharioudakis and Lanzas [9,10]. Zacharioudakis et al [9] performed a systematic review and meta-analysis assessing the prevalence of C. difficile colonization and the risk of developing infection; they reported an 8.1 % colonization prevalence among asymptomatic patients when first hospitalized, with a 5.9 times higher risk of CDI development compared to non-colonized patients during hospitalization.…”

“…Zacharioudakis et al [9] performed a systematic review and meta-analysis assessing the prevalence of C. difficile colonization and the risk of developing infection; they reported an 8.1 % colonization prevalence among asymptomatic patients when first hospitalized, with a 5.9 times higher risk of CDI development compared to non-colonized patients during hospitalization. While these rates appear substantial, only 8.1 % were colonized among all screened admits (n = 8725); of this smaller cohort (based on eight studies), 21.8 % developed CDI.…”

“…Acknowledging calculation biases, this would equate to *154 patients, or *1.8 % of the entire screened admitted population. Previously, hospitalized patients were 63 % more likely to be colonized [9]. Alternatively, Lanzas and Dubberke [10] used a model to determine the effectiveness of a C. difficile screening program among asymptomatic carriers at hospital admission; the model suggests that screening would reduce new colonizations and hospital-onset CDI cases.…”

Clostridium difficile-related postinfectious IBS: a case of enteroglial microbiological stalking and/or the solution of a conundrum?

“…It is worth noting that asymptomatic colonization with toxigenic strains is frequent and up to more than 20% of patients with a suspected such infection may have alternative etiologies for persistent diarrhea [5,6]. However, this pathogen, only in the United States, is responsible for half a million infections and it was associated with approximately 29,000 deaths in 2011 [7].…”

FMT in IBD: What Have We Learned?

“…Their center utilizes a two-step assay, which has been recommended in recently published clinical guidelines [14], with the enzyme immunoassay for toxins A and B enhancing specificity. Rates of C difficile colonization at the time of hospital admission are as high as 10% [15] possibly much higher in patients with IBD [16]. This group counted both enzyme immunoassay (EIA) toxin-positive patients and toxin-negative/PCR-positive patients as failures, though it could be argued the latter were carriers.…”