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Screening of Clostridioides difficile carriers in an urban academic medical center: Understanding implications of disease

Published online by Cambridge University Press:  11 December 2019


Sarah W. Baron
Affiliation:
Division of Hospital Medicine, Department of Medicine, Montefiore Medical Center, Bronx, New York Montefiore Medical Center, Bronx, New York Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
Belinda E. Ostrowsky
Affiliation:
Division of Infectious Disease, Department of Medicine, Montefiore Medical Center, Bronx, New York Montefiore Medical Center, Bronx, New York Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
Priya Nori
Affiliation:
Division of Infectious Disease, Department of Medicine, Montefiore Medical Center, Bronx, New York Montefiore Medical Center, Bronx, New York Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
David Y. Drory
Affiliation:
Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
Michael H. Levi
Affiliation:
Department of Pathology, Montefiore Medical Center, Bronx, New York Montefiore Medical Center, Bronx, New York Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
Wendy A. Szymczak
Affiliation:
Department of Pathology, Montefiore Medical Center, Bronx, New York Montefiore Medical Center, Bronx, New York Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
Michael L. Rinke
Affiliation:
Division of Pediatric Hospital Medicine, Department of Pediatrics, Children’s Hospital at Montefiore, Bronx, New York Montefiore Medical Center, Bronx, New York Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
William N. Southern
Affiliation:
Division of Hospital Medicine, Department of Medicine, Montefiore Medical Center, Bronx, New York Montefiore Medical Center, Bronx, New York Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
Corresponding
E-mail address:

Abstract

Objective:

Efforts to reduce Clostridioides difficile infection (CDI) have targeted transmission from patients with symptomatic C. difficile. However, many patients with the C. difficile organism are carriers without symptoms who may serve as reservoirs for spread of infection and may be at risk for progression to symptomatic C. difficile. To estimate the prevalence of C. difficile carriage and determine the risk and speed of progression to symptomatic C. difficile among carriers, we established a pilot screening program in a large urban hospital.

Design:

Prospective cohort study.

Setting:

An 800-bed, tertiary-care, academic medical center in the Bronx, New York.

Participants:

A sample of admitted adults without diarrhea, with oversampling of nursing facility patients.

Methods:

Perirectal swabs were tested by polymerase chain reaction for C. difficile within 24 hours of admission, and patients were followed for progression to symptomatic C. difficile. Development of symptomatic C. difficile was compared among C. difficile carriers and noncarriers using a Cox proportional hazards model.

Results:

Of the 220 subjects, 21 (9.6%) were C. difficile carriers, including 10.2% of the nursing facility residents and 7.7% of the community residents (P = .60). Among the 21 C. difficile carriers, 8 (38.1%) progressed to symptomatic C. difficile, but only 4 (2.0%) of the 199 noncarriers progressed to symptomatic C. difficile (hazard ratio, 23.9; 95% CI, 7.2–79.6; P < .0001).

Conclusions:

Asymptomatic carriage of C. difficile is prevalent among admitted patients and confers a significant risk of progression to symptomatic CDI. Screening for asymptomatic carriers may represent an opportunity to reduce CDI.


Type
Original Article
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved.

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Footnotes

PREVIOUS PRESENTATION: Portions of this research were presented at the Annual Meeting of the Society of Hospital Medicine on March 25, 2019, in National Harbor, Maryland, and at the Annual Meeting of the Society of General Internal Medicine on April 13, 2018, in Denver, Colorado.


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