Prevalence and Risk Factors for Asymptomatic Clostridium difficile Carriage.

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Prevalence and Risk Factors for Asymptomatic Clostridium difficile Carriage.

Clin Infect Dis. 2014 Apr 21;

Authors: Alasmari F, Seiler SM, Hink T, Burnham CA, Dubberke ER

Background. Clostridium difficile infection (CDI) incidence has increased dramatically over the last decade. Recent studies suggest asymptomatic carriers may be an important reservoir of C. difficile in healthcare settings. We sought to identify the prevalence and risk factors for asymptomatic C. difficile carriage on admission to the hospital. Methods. Patients admitted to Barnes-Jewish Hospital without diarrhea were enrolled from June, 2010, through October, 2011. Demographics and healthcare and medication exposures 90 days prior to admission were collected. Stool specimens or rectal swabs were collected within 48 hours of admission and stored at -30(°)C until cultured. C. difficile isolates were typed and compared to isolates from patients with CDI. Results. 259 subjects enrolled had an admission stool/swab specimen. 204 (79%) were not colonized, 40(15%) had toxigenic C. difficile (TCD), and 15 (6%) had nontoxigenic C. difficile. There were no differences between TCD colonized and uncolonized subjects for age (mean 56 vs.58, p=.46), comorbidities, admission from another healthcare facility (33% vs. 24%, p=.23), or recent hospitalization (50% vs. 50%, p=.43).There were no differences in antimicrobial exposures in the 90 days prior to admission (55% vs. 56%, p= .91). Asymptomatic carriers were colonized with strains similar to strains from patients with CDI, but the relative proportions were different. Conclusions. There was a high prevalence of TCD colonization on admission. In contrast to past studies, TCD colonization was not associated with recent antimicrobial or healthcare exposures. Additional investigation is needed to determine the role of asymptomatic TCD carriers on hospital-onset CDI incidence.

PMID: 24755858 [PubMed - as supplied by publisher]

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