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Detecting, isolating C. difficile carriers associated with reduced incidence of hospital-acquired infections
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Screening and isolating asymptomatic Clostridium difficile carriers was associated with lower incidence of health care-associated C. difficile infections at an acute care facility in Canada, according to research published in JAMA Internal Medicine.
The executive committee of the Quebec Heart and Lung Institute “endorsed a policy to detect and isolate asymptomatic [C. difficile] carriers in October 2013,” Yves Longtin, MD, of the Jewish General Hospital and McGill University, Montreal, Canada, and colleagues wrote. “The present study reports the effect of this strategy on the incidence of [health care-associated] CDI.”
From November 2013 through March 2015, 7,599 patients were screened at admission for the presence of the tcdB gene by polymerase chain reaction of rectal swab samples, and the 4.8% who were identified as carriers were placed under contact isolation during their hospitalization. The primary outcome was change in the incidence rate of health care-associated CDI per 10,000 patient days after the intervention was implemented.
Health care-associated CDI incidence rate was 3 per 10,000 patient-days during the intervention vs. 6.9 per 10,000 patient-days during the postepidemic preintervention period from July 2007 to November 2013 (P < .001). Although the intervention did not have an immediate effect, there was a significant decrease in trend over time of 7% per 4-week period (RR = 0.93; 95% CI, 0.87-0.99 per period).
Autoregressive integrated moving average modeling also showed the intervention had a significant effect represented by a gradual progressive decrease in the health care-associated CDI time series by an overall magnitude of 7.2 per 10,000 patient days. Forecast modeling estimated that the intervention prevented 62.4% of the 101 expected cases. Conversely, no significant decrease in health care-associated CDI rates occurred at control institutions in Quebec City (n = 6) and in the Province of Quebec (n = 94).
The researchers acknowledge the single-center intervention limits the study, and that further research is needed to confirm their findings. Moreover, they added that the savings in averted CDI was greater than the costs of the intervention ($130,000 to prevent about 63 cases).
L. Clifford McDonald
“The intervention is simple and could be easily implemented in other institutions,” they concluded. “If confirmed in subsequent studies, isolating asymptomatic carriers could potentially prevent thousands of cases of [health care-associated] CDI every year in North America.
“The results of this study are promising for reducing [health care-associated] CDI,” Alice Y. Guh, MD, MPH, and L. Clifford McDonald, MD, of the CDC, Atlanta, wrote in a related commentary. The researchers “have shown the possible benefit of using active surveillance testing and isolation of asymptomatic carriers for preventing [health care-associated] CDI. Larger, well-designed studies, such as cluster randomized trials, are ultimately needed to confirm the effectiveness of this strategy.” – by Adam Leitenberger
Disclosure: Longtin reports being a coapplicant on a patent held by The Royal Institution for the Advancement of Learning/McGill University on methods, reagents and kits for the assessment of bacterial infections. Please see the full study for a list of all other researchers’ relevant financial disclosures.
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