Highlights
- •In a large cohort, 4.05% of patients were colonized with Clostridium difficile on admission.
- •Risk factors for Clostridium difficile colonization on admission were identified.
- •Most patients with Clostridium difficile colonization carried non-NAP1, non-NAP2 strains.
Background
Clostridium difficile (CD) is the leading cause of health care–associated diarrhea and can result in asymptomatic
carriage. Rates of asymptomatic CD colonization on hospital admission range from 1.4%-21%.
The objective of this study was to evaluate host and bacterial factors associated
with colonization on admission.
Methods
The Consortium de recherche québécois sur le Clostridium difficile study provided data for analysis, including demographic information, known risk factors,
and potential confounding factors, prospectively collected for 5,232 patients from
6 hospitals in Quebec and Ontario over 15 months from 2006-2007. Stool or rectal swabs
were obtained for culture on admission. Pulsed-field gel electrophoresis was performed
on the isolates. The presence of antibody against CD toxins A and B was measured.
Results
There were 212 (4.05%) patients colonized with CD on admission, and 5,020 patients
were not colonized with CD. Multivariate logistic regression analysis showed that
hospitalization within the last 12 months, use of corticosteroids, prior CD infection,
and presence of antibody against toxin B were associated with colonization on admission.
Of patients colonized on admission, 79.4% had non-NAP1, non-NAP2 strains.
Conclusion
There are identifiable risk factors among asymptomatic CD carriers that could serve
in their detection and provide a basis for targeted screening.
Key Words
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Article info
Footnotes
Funding/support: This work was supported by the Consortium de Recherche sur le Clostridium difficile.
Additional information: The Consortium de Recherche sur le Clostridium difficile consists of the following partners: Fonds de la Recherche en Santé du Québec, Canadian Institutes of Health Research, Ministre de la Santé et des Services Sociaux du Québec, Institut National de Santé Publique du Québec, Health Canada, Centre Hospitalier de l'Université de Montréal, McGill University Health Centre, CHU de Québec, and CHU de Sherbrooke.
Conflicts of interest: None to report.
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© 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
