TY - JOUR

T1 - Asymptomatic carriers contribute to nosocomial Clostridium difficile infection

T2 - a cohort study of 4508 patients

AU - Blixt, Thomas

AU - Gradel, Kim Oren

AU - Homann, Christian

AU - Seidelin, Jakob Benedict

AU - Schønning, Kristian

AU - Lester, Anne

AU - Houlind, Jette

AU - Stangerup, Marie

AU - Gottlieb, Magnus

AU - Knudsen, Jenny Dahl

N1 - Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

PY - 2017

Y1 - 2017

N2 - BACKGROUND & AIMS: Nosocomial infection with Clostridium difficile pose a considerable problem despite numerous attempts by health care workers to reduce risk of transmission. Asymptomatic carriers of C difficile might spread their infection to other patients. We investigated the effects of of asymptomatic carriers on nosocomial C difficile infections.METHODS: We performed a population-based prospective cohort study at 2 university hospitals in Denmark, screening all patients for toxigenic C difficile in the intestine upon admittance, from October 1, 2012, to January 31, 2013. Screening results were blinded to patients, staff, and researchers. Patients were followed during their hospital stay by daily registration of wards and patient rooms. The primary outcomes were rate of C difficile infection in exposed and unexposed patients and factors associated with transmission.RESULTS: C difficile infection was detected in 2.6% of patients not exposed to carriers and in 4.6% of patients exposed to asymptomatic carriers, at the ward level (odds ratio for infection if exposed to carrier, 1.79; 95% CI, 1.16-2.76). Amount of exposure correlated with risk of C difficile infection, from 2.2% in the lowest quartile to 4.2% in the highest quartile of exposed patients (P=.026). Combining the load of exposure to carriers and length of stay seemed to have an additive effect on the risk of contracting C difficile.CONCLUSIONS: In a population-based prospective cohort study in Denmark, we found that asymptomatic carriers of toxigenic C difficile in hospitals increase risk of infection in other patients.

AB - BACKGROUND & AIMS: Nosocomial infection with Clostridium difficile pose a considerable problem despite numerous attempts by health care workers to reduce risk of transmission. Asymptomatic carriers of C difficile might spread their infection to other patients. We investigated the effects of of asymptomatic carriers on nosocomial C difficile infections.METHODS: We performed a population-based prospective cohort study at 2 university hospitals in Denmark, screening all patients for toxigenic C difficile in the intestine upon admittance, from October 1, 2012, to January 31, 2013. Screening results were blinded to patients, staff, and researchers. Patients were followed during their hospital stay by daily registration of wards and patient rooms. The primary outcomes were rate of C difficile infection in exposed and unexposed patients and factors associated with transmission.RESULTS: C difficile infection was detected in 2.6% of patients not exposed to carriers and in 4.6% of patients exposed to asymptomatic carriers, at the ward level (odds ratio for infection if exposed to carrier, 1.79; 95% CI, 1.16-2.76). Amount of exposure correlated with risk of C difficile infection, from 2.2% in the lowest quartile to 4.2% in the highest quartile of exposed patients (P=.026). Combining the load of exposure to carriers and length of stay seemed to have an additive effect on the risk of contracting C difficile.CONCLUSIONS: In a population-based prospective cohort study in Denmark, we found that asymptomatic carriers of toxigenic C difficile in hospitals increase risk of infection in other patients.

U2 - 10.1053/j.gastro.2016.12.035

DO - 10.1053/j.gastro.2016.12.035

M3 - Journal article

C2 - 28063955

VL - 152

SP - 1031-1041.e2

JO - Gastroenterology

JF - Gastroenterology

SN - 0016-5085

IS - 5

ER -