Presence of Clostridioides difficile and multidrug resistant healthcare-associated pathogens in stool specimens from hospitalized patients in the United States

Link to article at PubMed

Tickler IA, et al. J Hosp Infect 2020.


BACKGROUND: Healthcare-associated infections (HAI) continue to be a major cause of morbidity and mortality. Many HAI pathogens, including multidrug resistant organisms (MDROs), colonize the gastrointestinal tract.

AIM: The goal of this study was to determine the frequency of MDRO carriage in patients who do and do not harbor toxigenic Clostridioides difficile in their stools.

METHODS: Stool specimens received from nine U.S. laboratories were cultured using media selective for C. difficile, Staphylococcus aureus, vancomycin-resistant enterococci (VRE), and carbapenem-resistant gram-negative organisms (CRO). Specimens and isolates were also tested by PCR. Bacterial isolates underwent susceptibility testing and genotyping.

FINDINGS: Among 363 specimens, 175 yielded toxigenic C. difficile isolates spanning 27 PCR ribotypes. C. difficile (TCD+) stools harbored an additional 28 organisms, including six CRO (3.4%), of which two (1.1%) were carbapenemase producing organism (CPO), 19 VRE (10.9%), and three meticillin-resistant S. aureus isolates (MRSA 1.7 %). Stools that were culture negative for toxigenic-C. difficile (TCD-) yielded 26 organisms, including four CROs (2.1%), 20 VREs (10.6), and two MRSA (1.1%). Excluding C. difficile, no significant differences were seen in the rates of the MDROs between TCD+ and TCD-specimens.

CONCLUSION: Overall, 15.4% of the TCD+ stools and 11.2% of the TCD-stools carried at least one non-C. difficile MDRO pathogen, indicating that multiple MDROs may be present in the gastrointestinal tracts of patients, including those that harbor C. difficile.

PMID:32649974 | DOI:10.1016/j.jhin.2020.07.003

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