Risk Factors Can Form Basis of Targeted Hospital Screening Program for C. diff
Asymptomatic C. difficile (C. diff) colonization is present at hospital admission in nearly one of 10 patients, according to a study published in the May issue of the American Journal of Infection Control. Initiating screening based on three independent risk factors for colonization can be used as the basis for a targeted surveillance program to […]
Asymptomatic C. difficile (C. diff) colonization is present at hospital admission in nearly one of 10 patients, according to a study published in the May issue of the American Journal of Infection Control. Initiating screening based on three independent risk factors for colonization can be used as the basis for a targeted surveillance program to identify asymptomatic patients with colonization at admission, thereby potentially cutting in-hospital transmission. “While more research needs to be conducted on the transmission of C. difficile infection from colonized patients, this study may help institutions with persistently high rates of transmission develop an expanded strategy for targeted C. difficile surveillance,” said Patti Grant, RN, president of the Association for Professionals in Infection Control and Epidemiology, in a statement. Due to the steady climb (2004 to 2008) in health care-associated C. diff at Mayo Clinic-affiliated hospitals (in spite of the use of private rooms and contact precautions for patients with suspected or confirmed C. diff infection), researchers assessed data from 320 consenting adults, without symptoms of C. diff infection, admitted to a tertiary care hospital on 20 predetermined study days (March 1 through April 30, 2009). The first stool sample after admission was tested for toxigenic C. diff using polymerase chain reaction (PCR). Eighty percent of samples were received within 48 hours. Positive results for toxigenic C. diff were found in 9.7 percent of participants. Recent hospitalization, chronic dialysis, and corticosteroid use were independent predictors of C. diff colonization. Forty-eight percent of participants had one of the three risk factors, and screening these patients at admission would identify 74 percent of C. diff carriers, which the authors say is in the range of previously published screening efficiency rates for methicillin-resistant staphylococcus aureus (MRSA). “The risk of transmission from asymptomatic reservoirs is the rationale behind recommendations for active surveillance for health care-associated pathogens such as MRSA and vancomycin-resistant enterococci but identification of asymptomatic C. diff carriers is not currently recommended,” write the authors, led by Surbhi Leekha, MBBS. “Although the extent of contamination of health care workers and the environment from asymptomatically C. diff colonized individuals is less compared with patients with diarrhea, these asymptomatic C. diff carriers could be an important source of C. diff transmission.” The authors additionally note that a “significant practical limitation” to C. diff surveillance, anaerobic cultures, was overcome in this study with use of real-time PCR.