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Hospital food unlikely source for C. difficile acquisition
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Hospital food was unlikely to be a source of Clostridium difficile acquisition at Barnes-Jewish Hospital in St. Louis, according to data from a prospective cohort study conducted there.
“A potential reservoir and source for C. difficile acquisition is the food of hospitalized patients. C. difficile has been isolated from retail foods worldwide, including ground meats, poultry and vegetables,” Erik R. Dubberke, MD, MSPH, of the division of infectious diseases, Washington University School of Medicine, and colleagues wrote. “The spores of C. difficile are heat-resistant and thus may have the potential to survive cooking temperatures. Given the presence of C. difficile in food and its heat-resistant qualities, it is theoretically possible that hospitalized patients could be exposed to C. difficile from their food.”
From May 9, 2011 to July 12, 2012, the researchers collected stool or rectal swabs from 149 patients at Barnes-Jewish Hospital, a university-affiliated tertiary care center, and obtained 910 food specimens from the patients’ meals. To estimate the risk for acquiring C. difficile infection (CDI) from food, Dubberke and colleagues developed a mathematical model to simulate patient admissions, antimicrobial exposure, number of meals eaten daily and concentration of C. difficile.
Two food specimens (0.2%) from two patients (1.3%) contained C. difficile, Dubberke and colleagues reported. Neither patient had been colonized with C. difficile at baseline. Only one patient’s colonization status was available at discharge, and it was negative. Modeling predicted the mean number of patients exposed to C. difficile through hospital food was 12.7 per 1,000 admissions (95% CI, 12.542-12.858), and the mean number of predicted colonization events was 0.609 per 1,000 admissions (95% CI, 0.6-0.618).
“C. difficile is a ubiquitous organism, and only a minority of new C. difficile acquisitions in the hospital have been linked to another patient with CDI,” Dubberke and colleagues wrote. “Therefore, understanding all potential sources of C. difficile exposure in the hospital is necessary to inform prevention measures for CDI. Our findings indicate that food is unlikely to be a significant source of C. difficile acquisition in hospitalized patients.” – by Andy Polhamus
Disclosure: Dubberke reports being a consultant to Alere, Merck, Rebiotix, Sanofi Pasteur, Summit and Valneva. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
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Purna C. Kashyap
Clostridium difficile infection is the most common nosocomial infection, with nearly half a million cases and 29,000 deaths in a year, imposing a significant economic burden on the health care system. A proportion of hospital infections have been attributed to person-person transmission, but food as a potential reservoir for infections has previously not been investigated, even though C. difficile has been isolated from ground meats, poultry and vegetables. The heat-resistant nature of C. difficile spores makes it hypothetically possible to be transmitted in cooked food. In the prospective cohort study by Kwon and colleagues, a portion of the meal from 149 patients was tested for C. difficile in addition to their stool specimens. They found 0.2% of food cultures (two food specimens from two patients) to be positive for toxigenic C. difficile at low concentrations, hence this appears to be a rare event. The two patients did not have any symptoms and only one was tested and found to be negative for C. difficile. A modeling approach adopted by the authors suggested a less than 1 in 1,000 chance of C. difficile colonization by food-related exposure. While these findings will need to be corroborated in a larger multicenter cohort, food does not appear to be a major reservoir contributing to hospital-acquired C. difficile infections.
Disclosure:Kashyap reports no relevant financial disclosures.
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