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14% of patients at Ohio hospital positive for toxigenic C. difficile at admission
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Researchers found that 14% of patients at one acute-care hospital in Ohio had positive perirectal cultures for toxigenic Clostridioides difficile on admission — a “relatively high prevalence” they attributed to a sensitive culture method and a patient population with a high frequency of prior antibiotic use.
Many of the patients colonized on admission were later diagnosed with health care-associated C. difficile infection (CDI).
“Based on surveillance definitions, about two-thirds of [CDI] cases are classified as health care-associated. In these cases, it is presumed that the infecting strain was acquired in a hospital or long-term care facility,” Melany Gonzalez-Orta, MD, from the Louis Stokes Cleveland VA Medical Center and Cleveland Clinic Foundation, and colleagues wrote.
“However, recent studies using highly discriminatory molecular typing methods have demonstrated that many cases classified as health care-associated are not linked to other hospital-associated cases or to asymptomatic carriers of toxigenic C. difficile. Moreover, some studies suggest that a substantial proportion of patients diagnosed with health care-associated CDI were colonized on admission. If many CDI cases currently classified as health care-associated are not actually acquired in health care facilities, this would have important implications for infection prevention.”
Gonzalez-Orta and colleagues conducted a 6-month prospective cohort study of a convenience sample of patients who were newly admitted to the Cleveland VA Medical Center — a 215-bed acute-care facility with an adjacent long-term care facility — to determine the proportion of health care-associated CDI cases in which colonization with the infecting strain was present on admission.
Results showed that of the 480 patients enrolled, 68 (14%) had positive perirectal cultures for toxigenic C. difficile on admission.
“During the follow-up period, eight of the 68 (12%) patients with positive admission perirectal cultures for toxigenic C. difficile were diagnosed with CDI vs. five of 412 (1%) with negative admission perirectal cultures,” Gonzalez-Orta and colleagues explained.
According to the study, of the eight patients in that first group, seven (88%) had matching admission and CDI isolates, and six (75%) met criteria for health care-associated CDI.
“In our facility a substantial proportion of patients diagnosed with health care-associated CDI were colonized with the infecting strain on admission. Standard control measures focused on preventing transmission will not be effective in reducing infections in such patients,” the authors concluded. “Thus, our findings support the importance of antimicrobial stewardship and CDI test stewardship initiatives to reduce the potential for diagnosis of health care-associated CDI in asymptomatically colonized patients.” – by Caitlyn Stulpin
Disclosures: Gonzalez-Orta reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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