Universal screening for Clostridioides difficile in a tertiary hospital: risk factors for carriage and clinical disease.
Clin Microbiol Infect. 2019 Feb 13;:
Authors: Melzer E, Smollan G, Hupert A, Fluss R, Tal I, Gilboa M, Zilberman-Daniels T, Keller N, Rahav G, Regev-Yochay G, SHIC research group
OBJECTIVES: The role of asymptomatic carriers in CDI epidemiology is not fully understood. Our aim was to evaluate CD carriage prevalence on admission, associated risk factors and the risk to develop CDI.
METHODS: A ten-week surveillance program for CD carriage of all medical patients admitted to the Sheba Medical Center was implemented, utilizing admission rectal swab PCR (Xpert C. difficile; Cepheid). Healthcare Facility-Onset CDI (HO-CDI) was recorded and divided into HO-CDI diagnosed in CD carriers and non-carriers.
RESULTS: 4601 admissions were recorded in 3803 patients; 2368 patients had technically analyzable rectal swabs, of whom 81 (3.4%) were CD carriers. Multivariate logistic regression model showed that previous hospitalization, old age (>85y) and low Norton scores were significant independent predictors of CD carriage. Carriers were more likely to receive antimicrobial therapy during hospitalization than non-carriers were. The incidence of HO-CDI in non-carriers was 4.6 cases/10,000 patient-days; the incidence of HO-CDI in carriers was 76.7 cases/10,000 patient-days (RR=16.6, 95% CI=4.0-69.1, p=0.002).
CONCLUSIONS: In a prospective study, the rate of CD carriage on admission in medical patients was 3.4%. CD carriers were older, frailer and more likely to have been hospitalized recently. HO-CDI incidence was significantly higher among CD carriers than among non-carriers, with at least a third of CDI in screened patients developing in carriers. Targeted screening of high-risk groups for CD carriage should be further considered.
PMID: 30771530 [PubMed - as supplied by publisher]