Environmental shedding of toxigenic Clostridioides difficile by asymptomatic carriers: A prospective observational study

Houri-Levi, Esther; Tal, Ilana; Rubin, Carmit; Eden-Friedman, Yehudit; Rahav, Galia; Amital, Howard; Beni, Sharon; Ben-Zvi, Ilan; Blausov, Natasha; Brom, A.G.; Cohen, Carmit; Feld-Simon, Olga; Fluss, Ronen; Gilboa, Mayan; Halevy, Shiraz; Hupert, Amit; Jbarien, Amnah; Keller, Natan; Leibowitz, Avshalom; Mayan, Haim; Maizels, Leonid; Meltzer, Eyal; Pinas-Zade, Nani; Raibman-Spector, Shir; Regev‐Yochay, Gili; Romiantsev, Marina; Shachar, Dalit; Sharif, Κassem; Segal, Gadi; Segal, Shoshi; Segev, Amitai; Smollan, Gill; Stienlauf, Shmuel; Yonath, Hagit; Zilberman-Daniels, Tal; Zimlichman, Eyal

doi:10.1016/j.cmi.2019.12.011

Cited by 21 publications

(16 citation statements)

References 27 publications

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“…Several previously published studies identified C difficile in approximately 15% of samples overall and 17%–27% of samples from the patient bathroom [ 12 , 16 , 17 ]. In contrast, Davies et al [ 18 ] and Gilboa et al [ 19 ] identified C difficile in 30%–70% of samples from C difficile patient rooms, and Curry et al [ 20 ] identified C difficile in 5 of 6 colonized patient rooms but not primarily in the bathroom [ 18 , 19 ]. Although differences in recovery rate could be related to patient mix and timing of sampling, we suspect that the sampling technique contributed to these differences.…”

Section: Discussionmentioning

confidence: 99%

“…Although differences in recovery rate could be related to patient mix and timing of sampling, we suspect that the sampling technique contributed to these differences. Davies et al [ 18 ], Gilboa et al [ 19 ], and our study used the sponge and stomacher technique, which allows for sampling of a much larger surface area than contact plates or cotton swabs. In addition, Curry et al did not include the bathroom floor as a sample location as our study did, which likely contributed to our difference in findings in the bathroom.…”

Section: Discussionmentioning

confidence: 99%

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The Impact of Infection Versus Colonization on Clostridioides difficile Environmental Contamination in Hospitalized Patients With Diarrhea

Warren

Turner

Addison

et al. 2022

Open Forum Infectious Diseases

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Introduction Patients with Clostridioides difficile infections (CDI) contaminate the healthcare environment; however, the relative contribution of contamination by colonized individuals is unknown. Current guidelines do not recommend the use of contact precautions for asymptomatic C. difficile carriers. We evaluated C. difficile environmental contamination in rooms housing adult inpatients with diarrhea based on C. difficile status. Methods We performed a prospective cohort study of inpatient adults with diarrhea who underwent testing for CDI via PCR and enzyme immunoassay. Patients were stratified into cohorts based on test result: infected (PCR +/EIA +), colonized (PCR +/EIA -) or negative/control (PCR -). Environmental microbiological samples were taken within 24 hours of C. difficile testing and again for two successive days. Samples were obtained from the patient, bathroom, and care areas. Results We enrolled 94 patients between November 2019 and June 2021. C. difficile was recovered in 93 (38%) patient rooms: 44 (62%) infected patient rooms, 35 (43%) colonized patient rooms (p=0.08 vs. infected 38 patient rooms), and 14 (15%) negative patient rooms (p<0.01 vs. infected; p<0.01 vs. colonized). C. difficile was recovered in 40 (56%), 6 (9%) and 20 (28%) of bathrooms, care areas and patient areas in 40 infected patient rooms; 34 (41%), 1 (1%), and 4 (5%) samples in colonized patient rooms; and 12 (13%), 41 1 (1%), and 3 (3%) of samples in negative patient rooms, respectively. Conclusion Patients colonized with C. difficile frequently contaminated the hospital environment. Our data support the use of contact precautions when entering rooms of patients colonized with C. difficile, especially when entering the bathroom.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Impact of Infection Versus Colonization on Clostridioides difficile Environmental Contamination in Hospitalized Patients With Diarrhea

Warren

Turner

Addison

et al. 2022

Open Forum Infectious Diseases

View full text Add to dashboard Cite

show abstract

“…An investigation to compare the burden of environmental shedding of toxigenic C. difficile among asymptomatic carriers, CDI patients and non-carriers in non-epidemic settings showed more than residual contamination in 41% of carrier rooms—24% of these were heavily contaminated. Moreover, multivariate analysis showed that the contamination score of rooms of asymptomatic carriers did not differ from rooms of CDI patients [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Clostridioides (Clostridium) Difficile Infection and Colonization: Ongoing Prospective Cohort Study in a French University Hospital

Khanafer

Vanhems

Bennia

et al. 2021

IJERPH

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Introduction: Clostridioides (Clostridium) difficile can be isolated from stool in 3% of healthy adults and in at least 10% of asymptomatic hospitalized patients. C. difficile, the most common cause of hospital-acquired infectious diarrhea in the developed world, has re-emerged in recent years with increasing incidence and severity. In an effort to reduce the spread of the pathogen, published recommendations suggest isolation and contact precautions for patients suffering from C. difficile infection (CDI). However, asymptomatic colonized patients are not targeted by infection control policies, and active surveillance for colonization is not routinely performed. Moreover, given the current changes in the epidemiology of CDI, particularly the emergence of new virulent strains either in the hospital or community settings, there is a need for identification of factors associated with colonization by C. difficile and CDI. Methods and analysis: We are carrying out a prospective, observational, cohort study in Edouard Herriot Hospital, Hospices Civils de Lyon, a 900-bed university hospital in Lyon, France. All consecutive adult patients admitted on selected units are eligible to participate in the study. Stool samples or rectal swabs for C. difficile testing are obtained on admission, every 3–5 days during hospitalization, at the onset of diarrhea (if applicable), and at discharge. Descriptive and logistic regression analyses will be completed to mainly estimate the proportion of asymptomatic colonization at admission, and to evaluate differences between factors associated with colonization and those related to CDI. Ethics: The study is conducted in accordance with the ethical principles of the Declaration of Helsinki, French law, and the Good Clinical Practice guidelines. The study protocol design was approved by the participating units, the ethics committee and the hospital institutional review board (Comité de protection des personnes et Comission Nationale de l’Informatique et des Libertés; N°: 00009118). Dissemination: The results of this study will be disseminated by presenting the findings locally at each participating ward, as well as national and international scientific meetings. Findings will be shared with interested national societies crafting guidelines in CDI.

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“…difficile colonization is more frequent than active disease in the hospital, with a prevalence estimated at 3-26% among adult patients in acute care hospitals [93,94]. Previous studies have suggested that asymptomatic carriers of toxigenic strains could be a potential reservoir for hospital-acquired infections via direct patient-to-patient transmission and hospital environment contamination [95][96][97][98][99][100]. However, the role of asymptomatic carriage as a source of spread in the hospital is controversial and the impact on subsequent development of active disease is not yet fully understood.…”

Section: Asymptomatic Carriage and Potential Disseminationmentioning

confidence: 99%

Clostridioides difficile Infection, Still a Long Way to Go

Kampouri

Croxatto

Prod’hom

et al. 2021

JCM

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Clostridioides difficile is an increasingly common pathogen both within and outside the hospital and is responsible for a large clinical spectrum from asymptomatic carriage to complicated infection associated with a high mortality. While diagnostic methods have considerably progressed over the years, the optimal diagnostic algorithm is still debated and there is no single diagnostic test that can be used as a standalone test. More importantly, the heterogeneity in diagnostic practices between centers along with the lack of robust surveillance systems in all countries and an important degree of underdiagnosis due to lack of clinical suspicion in the community, hinder a more accurate evaluation of the burden of disease. Our improved understanding of the physiopathology of CDI has allowed some significant progress in the treatment of CDI, including a broader use of fidaxomicine, the use of fecal microbiota transplantation for multiples recurrences and newer approaches including antibodies, vaccines and new molecules, already developed or in the pipeline. However, the management of CDI recurrences and severe infections remain challenging and the main question remains: how to best target these often expensive treatments to the right population. In this review we discuss current diagnostic approaches, treatment and potential prevention strategies, with a special focus on recent advances in the field as well as areas of uncertainty and unmet needs and how to address them.

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Environmental shedding of toxigenic Clostridioides difficile by asymptomatic carriers: A prospective observational study

Cited by 21 publications

References 27 publications

The Impact of Infection Versus Colonization on Clostridioides difficile Environmental Contamination in Hospitalized Patients With Diarrhea

The Impact of Infection Versus Colonization on Clostridioides difficile Environmental Contamination in Hospitalized Patients With Diarrhea

Factors Associated with Clostridioides (Clostridium) Difficile Infection and Colonization: Ongoing Prospective Cohort Study in a French University Hospital

Clostridioides difficile Infection, Still a Long Way to Go

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