Impact of Isolating Clostridium difficile Carriers on the Burden of Isolation Precautions: A Time Series Analysis

Xiao, Yasi; Paquet-Bolduc, Bianka; Garenc, Christophe; Gervais, Philippe; Trottier, Sylvie; Roussy, Jean-François; Longtin, Jean; Loo, Vivian G.; Longtin, Yves

doi:10.1093/cid/cix1024

Cited by 10 publications

(9 citation statements)

References 28 publications

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“…We conducted a time series analysis, common for assessing changes in hospital-acquired infections, [18][19][20] using a random-effects regression model examining: ED wait times and HA-CDI rates, limited to patients entering through the ED.…”

Section: Random-effects Regressionmentioning

confidence: 99%

Can Emergency Department Wait Times Predict Rates of Hospital-Acquired Clostridioides difficile Infection? A Study of Acute Care Facilities in New York State

Durant

Guerrazzi-Young

2021

J Patient Saf

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ObjectiveClostridioides difficile is the most common hospital-acquired pathogen and persists in the environment for extended periods. As a common entry point for patients with diarrhea, and a setting providing fast-paced, high-volume care, emergency departments (EDs) are often sites of C. difficile contamination. This study examined the relationship between average patient wait times in the ED before admission and overall hospital-acquired C. difficile infection (HA-CDI) rates in New York State acute care hospitals.MethodsA random-effects regression analysis compared each facility’s annual average ED wait time for admitted patients with that facility’s average (HA-CDI) rates for patients entering through the ED. This model controlled for known clinical and nonclinical predictors of HA-CDI: average length of stay; case mix index; total discharges, a measure of hospital size; and percent Medicare discharges, a proxy for advanced age.ResultsEmergency department wait times had a significant and positive relationship with HA-CDI rates. Facilities experience an additional 0.002 cases of HA-CDI per 1000 patient discharges with every additional minute patients spend in the ED (P = 0.003), on average. Emergency department wait times also had the largest effect size (0.210), indicating that they explain more of the variance in HA-CDI rates for patients entering through the ED than some of the best-known predictors of HA-CDI.ConclusionsThe relationship between ED wait times and eventual HA-CDI warrants further exploration. These findings suggest efforts to reduce ED wait times for admitted patients or more rigorous environmental cleanliness strategies in the ED, as possible avenues for HA-CDI prevention.

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Section: Random-effects Regressionmentioning

confidence: 99%

Can Emergency Department Wait Times Predict Rates of Hospital-Acquired Clostridioides difficile Infection? A Study of Acute Care Facilities in New York State

Durant

Guerrazzi-Young

2021

J Patient Saf

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“…In a segmented time series analysis by Xiao et al . 9 , isolating asymptomatic carriers in addition to isolating infected patients decreased the prevalence of isolation days for C. difficile from the pre-intervention period when surveillance for asymptomatic carriers was not performed. More data on the usefulness of probiotics have emerged.…”

Section: Clostridium Difficile Infectionmentioning

confidence: 99%

Recent advances in understanding the epidemiology of healthcare-associated infections

Sreeramoju

2019

F1000Res

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“…Since then, other circulating strains have emerged as the prevalent strains causative of CDI, such as 078 and 014/020 [7][8][9] . One report indicated that the prevalence of PCR ribotype 027 decreased from 26.2% in 2012 to 16.9% in 2016 9 . As the landscape of C. difficile epidemiology continues to evolve, we must update our understanding of how various strains of this pathogen evolve, spread, and cause disease.…”

Section: Introductionmentioning

confidence: 99%

“…While asymptomatic carriers of C. difficile have not been a significant focus of infection prevention efforts, studies have shown these carriers do shed viable, toxigenic C. difficile to their surroundings that could cause disease 14 . Several studies have shown evidence of a reduction in CDI cases if asymptomatic carriers are put on similar contact precautions to CDI patients [15][16][17] , but this has not been consistently found 18 . Correspondingly, it is critical to understand if C. difficile carriers are major contributors to new C. difficile acquisition or CDI manifestation in hospitalized patient populations.…”

Section: Introductionmentioning

confidence: 99%

Genomic surveillance ofClostridioides difficiletransmission and virulence in a healthcare setting

Newcomer,

Fishbein,

Zhang

et al. 2023

Preprint

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Clostridioides difficileinfection (CDI) is a major cause of healthcare-associated diarrhea, despite the widespread implementation of contact precautions for patients with CDI. Here, we investigate strain contamination in a hospital setting and genomic determinants of disease outcomes. Across two wards over six months, we selectively culturedC. difficilefrom patients (n=384) and their environments. Whole-genome sequencing (WGS) of 146 isolates revealed that mostC. difficileisolates were from clade 1 (131/146, 89.7%), while only one isolate of the hypervirulent ST1 was recovered. Of culture-positive admissions, 17% of patients were diagnosed with CDI upon admission. We defined 29 strain networks at ≤ 2 core gene SNPs; 2 of these networks contain strains from different patients. Strain networks were temporally linked (p<0.0001). Across networks and over time, we found a minority of networks contained differences in phage populations. To understand genomic correlates of disease, we conducted WGS on an additional cohort ofC. difficile(n=102 isolates) from the same hospital and confirmed that clade 1 isolates are responsible for most CDI cases. We found that while toxigenicC. difficileisolates are associated with the presence ofcdtR, nontoxigenic isolates have an increased abundance of prophages. Our pangenomic analysis of clade 1 isolates suggests that while toxin genes (tcdABER and cdtR) were associated with CDI symptoms, they are dispensable for patient colonization. These data indicate toxigenic and nontoxigenicC. difficilecontamination persists in a hospital setting and highlight further investigation into how accessory genomic repertoires contribute toC. difficilecolonization and disease.

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Impact of Isolating Clostridium difficile Carriers on the Burden of Isolation Precautions: A Time Series Analysis

Abstract: Isolating CD carriers led to an initial increase in isolation needs that was partially compensated by a decrease in isolation needs for CDI.

Cited by 10 publications

References 28 publications

Can Emergency Department Wait Times Predict Rates of Hospital-Acquired Clostridioides difficile Infection? A Study of Acute Care Facilities in New York State

Can Emergency Department Wait Times Predict Rates of Hospital-Acquired Clostridioides difficile Infection? A Study of Acute Care Facilities in New York State

Recent advances in understanding the epidemiology of healthcare-associated infections

Genomic surveillance ofClostridioides difficiletransmission and virulence in a healthcare setting

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