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An Evaluation of Food as a Potential Source for Clostridium difficile Acquisition in Hospitalized Patients

Published online by Cambridge University Press:  03 October 2016

Jennie H. Kwon*
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Cristina Lanzas
Affiliation:
Department of Population Health and Pathobiology, North Carolina State University, Raleigh, North Carolina
Kimberly A. Reske
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Tiffany Hink
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Sondra M. Seiler
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Kerry M. Bommarito
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Carey-Ann D. Burnham
Affiliation:
Departments of Pathology & Immunology, Molecular Microbiology, and Pediatrics, Washington University School of Medicine, St. Louis, Missouri
Erik R. Dubberke
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
*
Address correspondence to Jennie H. Kwon, MSCI, Washington University School of Medicine, Division of Infectious Diseases, 660 S Euclid Ave, Campus Box 8051, St. Louis, MO 63110 (JKwon@wustl.edu).

Abstract

OBJECTIVE

To determine whether Clostridium difficile is present in the food of hospitalized patients and to estimate the risk of subsequent colonization associated with C. difficile in food.

METHODS

This was a prospective cohort study of inpatients at a university-affiliated tertiary care center, May 9, 2011–July 12, 2012. Enrolled patients submitted a portion of food from each meal. Patient stool specimens and/or rectal swabs were collected at enrollment, every 3 days thereafter, and at discharge, and were cultured for C. difficile. Clinical data were reviewed for evidence of infection due to C. difficile. A stochastic, discrete event model was developed to predict exposure to C. difficile from food, and the estimated number of new colonization events from food exposures per 1,000 admissions was determined.

RESULTS

A total of 149 patients were enrolled and 910 food specimens were obtained. Two food specimens from 2 patients were positive for C. difficile (0.2% of food samples; 1.3% of patients). Neither of the 2 patients was colonized at baseline with C. difficile. Discharge colonization status was available for 1 of the 2 patients and was negative. Neither was diagnosed with C. difficile infection while hospitalized or during the year before or after study enrollment. Stochastic modeling indicated contaminated hospital food would be responsible for less than 1 newly colonized patient per 1,000 hospital admissions.

CONCLUSIONS

The recovery of C. difficile from the food of hospitalized patients was rare. Modeling suggests hospital food is unlikely to be a source of C. difficile acquisition.

Infect Control Hosp Epidemiol 2016;1401–1407

Type
Original Articles
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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